IPE Midterm

Definition of an Empty Stomach

X amount of hours after your last meal

Health literacy involves a patents ability to:

• read health information

• understand prose (lamguage)

• interpret documents

• comunicate in writting

• use numeracy (dosing)

Literacy impacts

• persons access to information

• ability to understand meaning

• ability to navigate highly literate environments of modern society

individual and systemic factors that impact health literacy

• communication skills

• knowledge on health topics

• culture and language

• demands of heath care systems

• demands of the situation or context

teach back technique

a way of communicating with patients keeping health literacy in mind to confirm that the patient is understanding the information they are receiving

oral health literacy

the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make oral health decisions.

What do you need to be health literate?

1. Visually literate: understand graphs or other visual information.

2. Computer literate: operate a computer

3. Information: able to obtain and apply relevant information

4. Numerically or Computationally: able to calculate or reason numerically

Outcomes Associated with Limited Health Literacy

• poor self-reported health

• worse management of chronic conditions

• lower use of preventative and screening services

• greater reliance on emergency and acute care

• more treatment of advanced disease and complications

• higher healthcare costs

Behaviors that may indicate limited health literacy

• frequently miss appointments or arrive unprepared

• incomplete of inaccurately complete forms

• say they understand, but are unable to explain instructions

• avoid reading materials

• rely on family members

• have difficulty explaining their medical history

• Ask few or no questions

• Appear anxious or embarrassed or withdrawn

• Fail to follow home-care, medication or post-operative instruction

• Use emergency services instead of preventative or routine care

How to evaluate a patients health literacy before, during, and after treatment

before: use surveys or interviews to assess baseline knowledge

during: monitor engagement through questions or interactive tools

after: gather feedback through follow-up surveys or focus groups to ensure comprehension

Health

a state of complete physical, mental ad social wellbeing (not merely the absence of disease)

Wellbeing

the positive term used for health viewed as the opposite of disease

Wellness

the active pursuit of activities, choices and lifestyles that lead to a state of holistic health

Emotional wellness

ability to express feelings, manage stress and adjust to change

occupational wellness

participating in activities that provide meaning and purpose

intellectual wellness

lifelong learning, applying knowledge gained and sharing it with others

environmental wellness

feeling and being in a safe, clean and healthy environment

financial wellness

having a sense of control and knowledge of personal finances

social wellness

developing a sense of connection, belonging and having a positive support system

physical wellness

healthy eating, physical exercise and getting adequate rest

spiritual wellbeing

having meaning and purpose

Subcategories of wellbeing

emotional

spiritual

physical

social

financial

environmental

intellectual

occupational

emotional

Health promotion

enabling ppl to increase control over and improve their health.

comprehensive social and political process including improving skills and abilities to increase control over the determinants of health and actions towards changing conditions to address their impact on public and individual health.

Factors affecting heath

political

economic

social

cultural

environment

behavioral

biological

goals of health promotion

increase awareness

improve health

prevent disease

motivate patients to take control of their health

decrease complications

Positive impacts of health promotion

reduces inequalities

reduces pressure on services

makes healthier choices easier

its cost effective and efficient

The process of health promotion

focus, strategies, impact, outcomes (better quality of life)

authoritative health promotion

Top down health promotion from authority down to people

Negotiated health promotion

Bottom up health promotion from the people to the authority

Pender’s Health Promotion model

based on the idea that peoples experiences affect their outcomes

• looks the ppls lifestyle’s, psychological health and social and cultural env. to understand their health related decisions

Health Belief Model

focuses on individuals beliefs abt health conditions which predict individual health related behaviors

• perceived susceptibility, severity, benefits

• cues to action (perceived barriers)

• self efficacy (confidence in ability to succeed

Transtheoretical model

1. pre-contemplation

2. contemplation

3. preparation

4. action

5. maintenance

6. termination

Theory of Reasoned Action

assumes that a person will act a certain way on a health issue depending on their willingness due to subjective norms

Diffusion of innovation theory

Community and organization participation model investigates how a new idea or healthy behavior is disseminated in a social structure or community and identifies what influences how quickly the idea or behavior is adopted.

Best health models that should be applied

health promotion

health belief

transtheoretical

Health education

any combination of learning experiences designed to help individuals and communities improve their health by increasing knowledge, influencing motivation and improving heath literacy

The spectrum for prevention of disease

1. influencing policy and legislation

2. changing organizational practices

3. fostering coalitions and networks

4. educating providers

5. promoting community education

6. strengthening individual knowledge and skills

Health promotion vs health education

promotion enables people to increase control over and improve their health by promoting health awareness

education imparts knowledge and skills to develop and maintain behaviors and attitudes that lead to better health and wellness by focusing on a single problem and giving education on the topic

disease prevention

population based and individual based interventions for primary and secondary prevention aiming to minimize the burden of disease and associated risk factor

primary disease

remove disease risk factors - no disease - still preventing disease

secondary disease

early detection and treatment of asymptomatic disease with disease prevention

tertiary disease

present disease in clinical course and our goal is to reduce any further complications with disease prevention

upstream determinants of health issues

• environment

• housing

• nutrition

• education

• income

most prevalent chronic dental disease in children and adults?

dental caries because of increased prevalence and they have multifactorial etiology

severe early childhood caries

at least 1 tooth affected by smooth-surface caries

• one or more surfaces (missing or filled) age < 3

• 4 or more surfaces (missing or filled) age 3

• 5 or more surfaces (missing or filled) age 4

• 6 or more surfaces (missing or filled) age 5

teeth mostly effected by caries

permanent molars

DMFT Index

tells you prevalence of disease in patient but doesn’t tell you other teeth at risk or severity of the situation (all missing vs all decayed are very different possible outcomes)

• Decayed teeth

• Missing teeth due to caries

• Filled teeth

D+M+F = DMFT score (can’t count teeth more than once)

oral disease (caries) impacts on communities

• high prevalence

• expensive

• impact on individuals

• affects quality of life

• causes are known (preventable)

• easy and cheap to prevent

• diagnosis is easy

• impact underserved communities disproportionately

caries (ECC) as a childhood disease

most common chronic disease of childhood, established before age 2

downstream effects of early childhood caries

1. cost (missing school, work)

2. family associated morbidity (dysfunction, stress, lost jobs, loss of focus)

3. hospital costs (abx, other infections)

4. death

Cost effectiveness of preventative dental visits

the earlier a child goes to the dentist for routine preventative care, the less they spend overall in life on dental related costs

Strategies to prevent and control ECC

promote systems of care (integrate oral health and care and provide access)

preventing and controlling disease (stop/delay decay, identify early signs, treat tooth decay, prevent future decay)

Best ways to prevent early childhood tooth decay

• expert opinion

• theoretical rationale

• research

• field lessons

most common chronic childhood disease

dental caries (5x more common than asthma)

ADA recommended pediatric age for first visit

as soon as they have their first tooth or first birthday, whichever comes first.

most common caries in children

pit and fissure

highest risk teeth for caries

permanent first and second molars

preventative measure against ECC

pit and fissure sealants - drop decay in molars by 60% for up to 5 years

sealants impact when placed over caries

caries dont progress if no more than halfway through the dentin of the tooth

most frequent cause of infant deaths in MI

low birth weight

pregnancy impacts on peri-natal oral health

• periodontal disease in mom can have negative pregnancy outcomes (low birth weight)

maternal child transmission of caries

begins around 6 months post-partum via bacteria in saliva (can be more or less prevalent based on genetic strep makeup)

most common carrious chronic disease ages

6-9 y/o - permanent premolar eruption

13-15 y/o - permanent molar eruption

preventative measures for caries research proven

• fluoridated water

• pit and fissure sealants

ONLY PROVEN METHODS

treatments/procedures for children 0-5 y/o to prevent caries

to prevent ECC on smooth surface

• fluoride varnish (smooth surfaces)

• screening

• able to prevent tooth decay sooner

treatments/procedures for children 6-8 and 12-14 y/o to prevent caries

to prevent pit and fissure caries

• sealants (pit and fissures)

• school linked mobile clinics

Reason patients dont take prescription drugs as prescribed

due to cost (can be related to which patients also have poor oral health)

caries experience

the presence of treated and untreated caries - proxy for caries prevention

T/F caries experience is a proxy for prevention

True

large cause of tooth loss in adults

gum disease and lack of regular dental visits.

reasons seniors do not visit the dentist

• cost

• no original teeth

• fear of the dentist

community water fluoridation amount

0.7 ppm - benefits all residents served by community water supplies regardless of socioeconomic status.

when treating a lot of caries on a 5 y/o

varnish for smooth surfaces - focus on and attack the active problem

fluoride topical interaction on enamel

remineralizes with more acid-resistant HAP (resistant to tooth decay)

Fluoride interaction with bacteria

fluoride inhibits glycolysis and inhibits dextran formation

Fluoride developmental interaction with enamel

reduction in enamel solubility

Dental Fluorosis

over exposure and ingestion of fluoride during enamel formation in childhood

oral status of patients 65 y/o +

46.3% visit yearly

17.3% have no teeth left

36% have lost 6+ teeth

what is considered non-functional dentition

lost more than 6 teeth - cant get proper nutrition

fluoride in public water range (why)

0.7-1.2 ppm depending on maximum daily air pressure

epidemiology

the study of the distribution and determinants of health related states or events, and the application of this study to the control of diseases and other health problems.

descriptive epidemiology

concerns activities related to identifying possible causes related to identifying possible causes for the occurrence of diseases

• who, what, where, when, distribution

analytical epidemiology

includes activities related to characterizing the distribution of diseases within a population

• experimental and observational studies

Scope of Practice for dental therapists

Dental therapists work under
the supervision of a dentist to
perform tasks such as filling
cavities, placing temporary
crowns, and simple tooth
extractions

medicare

care for elderly population (does not include dental coverage)

experimental studies

altering one or more factor and examine effects

• uncontrolled trials

• controlled trials

controlled trials

trials with a control group of comparison

• non-randomized

• randomized

uncontrolled trials

trials without a control group for comparison

observational studies

observation made without intervention

• cohort study

• case-control study

• cross sectional study

cross-sectional study timeline

looks at the present state of the study

prospective cohort study timeline

looks at the present moment moving forward of the case

retrospective cohort study timeline

looks at everything in the case from present to the past that caused it

case control study timeline

looks at everything in the case from present to the past that caused it

cohort study

study incidence, causes and prognosis (prospective or retrospective) identifying exposed and unexposed and difference between their incidence or relative risk

teeth finish erupting between what ages

17-25 y/o

Case control study

used to study rare diseases or outcomes and measures exposure or risk of adverse outcomes, comparing the presence or absence of exposure in cases and controls

cross sectional study

assess the prevalence of disease by selecting participants and measuring the persons condition at a present point in time

incidence

The number of new
cases, episodes or
events occurring
over a defined
period of time,
commonly one
year

Methods with evidence for caries prevention

sealants and water fluoridation

calculating incidence rate

# of new cases of disease occurring during a
specific period / # of persons at risk of developing the disease
during that same period