community final exam (not complete)

public health

• is concerned with the health of all, “people’s health” through health protection, disease prevention, and health promotion

• Focuses on the aggregate health of the entire population, state, nation, or group not just on health services for individuals

• The effort to promote physical and mental health and prevent disease, injury, and disability

goal of public health

• to protect and promote the public’s health across three essential domains

  • prevent epidemics and the spread of disease

  • protect against environmental hazards

  • prevent injuries

  • promote and encourage healthy behaviors

  • respond to disasters and assist communities in recovery

  • ensure the quality and accessibility of health services

dental public health

• Focuses on oral health care and the education of a population with an emphasis on the utilization of dental hygiene sciences

• the science and art of preventing and controlling dental disease and promoting dental health through organized community efforts.

• the form of dental practice, which serves the community as the patient rather than the individual. It is concerned with the dental health education of the public, with research and the application of the findings of research with the administration of programs of dental care for groups and with the prevention and control of dental disease through a community approach.

primary prevention

• prevents disease from occurring

• ex: community water fluoridation, fluoride varnish before disease, sealants

secondary prevention

• terminating the disease process

• example: fluoride varnish on white spots (demineralized tooth surfaces)

tertiary prevention

• replaces lost tissues

• examples: dentures or implants to replace lost teeth

factors affecting dental public health

• oral health disparities are differences in disease burden and access among population groups

• social and economic conditions shape risk and ability to obtain care

• the aging population

• malpractice

• dental insurance

• cultural influences

• access to care

• infrastructure: programs available, funding

• workforce shortages

• dental hygiene is prevention-based

• advanced DH practitioner practice model

Dr. John Snow

• The founder of modern-day epidemiology

• polluted public water well in 1854 led to a cholera outbreak- responsible for tracing back the cause

Dr. Frederick McKay

• is partially credited for discovering fluoridation

• began an investigation that ultimately indicated that what he was seeing was dental fluorosis caused by too much naturally occurring fluoride in the water supply

• same patients exhibited far fewer caries than his other patients, revealing the benefit of fluoridated water

preventive modalities in oral care

• dental hygiene treatment

• fluorides and fluoridation

• fluoride preventive

• dental sealants

• xylitol

• alternative restorative treatment

• oral cancer screenings

• nutritional counseling

• athletic mouthguards

• education and health promotion

preventative dental public health

• Focuses on oral health care and the education of a population with an emphasis on the utilization of dental hygiene sciences

1798

• president john adams signed an act into law for the relief of sick and disabled seamen was passed, establishing a federal network of hospitals for the care of merchant seamen; a forerunner of today’s US Public Health Service.

1871

• The first supervising surgeon, John Maynard Woodworth (later Surgeon General), was appointed to the Marine Hospital Service, which had been organized the prior year.

• adopted a military model for his medical staff as part of a system reform. He instituted examinations for applicants, put physicians in uniforms, and created a cadre of mobile, career-service physicians who could be assigned to various marine hospitals.

1887

• The federal government opened a one-room laboratory on Staten Island for research on disease, thereby planting the seed that was to grow into the National Institutes of Health. (NIH)

1906

• Congress passed the Pure Food and Drugs Act, authorizing the government to monitor the purity of foods and the safety of medicines, now the responsibility of the Food and Drug Administration

1921

• The Bureau of Indian Affairs Health Division, the forerunner to the Indian Health Service, was created.

1946

• The Communicable Disease Center, forerunner of the Centers for Disease Control and Prevention, was established

1961

• The First White House Conference on Aging was held.

1964

• The first Surgeon General’s Report on Smoking and Health was released.

1965

• The Medicare and Medicaid programs were created, making comprehensive health care available to millions of Americans. In addition, the Older Americans Act created the nutritional and social programs administered by HHS Administration on Aging, and the Head Start program was created

1966

• The International Smallpox Eradication program led by the US Public Health Service was established; the worldwide eradication of smallpox was accomplished in 1977.

1970

• The National Health Service Corps was established

1990

• The Human Genome Project was established, and the Nutrition Labeling and Education Act was passed to authorize nutritional labeling of food

1993

•The Vaccines for Children Program was established, providing free immunizations to all children in low-income families.

1995

The Social Security Administration became an independent agency

1996

The Health Insurance Portability and Accountability Act (HIPAA) was enacted.

1997

The State Children’s Health Insurance Program (SCHIP) was created, which enables states to extend health coverage to more uninsured children.

1999

The initiative on combating bioterrorism was launched.

2002

The Office of Public Health Emergency Preparedness was created to coordinate efforts against bioterrorism and other emergency health threats

2003

The Medicare Prescription Drug Improvement and Modernization Act was enacted—the most significant expansion of Medicare since its enactment, including a prescription drug benefit.

2010

The Affordable Care Act was signed into law, putting in place comprehensive US health insurance reforms

2017

•Affordable Care Act “ overhaul”

the connecticut dental hygienists association

• first president was irene newman, the first dental hygienist with her 19 class members in 1914 Bridgeport connecticut

• objective of newly formed association was "to educate the public in, and to advance the cause of, mouth hygiene for the mutual improvement of its members, and to assist as far as lie within its power in the prevention of disease."

immunizations (small pox)

Dr. Edward Jenner’s discovery lead to

public vs individual clinical care

• Individual clinical care assesses and treats a particular patient according to that person's needs.

• Public health uses population data to identify shared needs and risk factors, then develops organized interventions that can reach groups.

• Public health may still deliver individual services, but its purpose is to improve population health, reduce disparities, and prevent disease on a community scale.

reasons cited for opposition to water fluoridation

Violation of personal freedom

•Cause of disease(s) and/or medical conditions: cancer, AIDS, fatigue, etc.

•Forced medication

•Communist plot

Abuse of police power

Dr. Alfred Fones

• Coined the term dental hygienist, which placed focus on the necessity of preventive services as a scientifically valid treatment modality

• envisioned preventative professional who would provide education and prevention services outside private dental offices especially in schools

present mission of ADHA

• to improve the public’s total health by working to advance the art and science of dental hygiene by ensuring access to quality oral health care

• increasing awareness of the cost-effective benefits of prevention

• promoting the highest standards of dental hygiene education, licensure, practice and research, and representing and promoting the interests of dental hygienists

• promote policies that provide access to preventative care

ADHA

Represents more than 150,000 registered dental hygienists.

•Each of the fifty state dental hygiene associations is a constituent member.

•Constituent organizations serve the components in their jurisdictions by informing them of national policies and programs and actively working on legislative issues.

•Components are the local associations and work at grass root efforts.

preventive

• Dental hygiene as a discipline has a foundation in _ care

dental care delivery in the united states

• involves mostly private dental practices and some government entities

• oral health is a major unmet need but is integral to total health and well being

• impacted by many federal and state governmental entities

• trends are suggesting more public funding for dental care in future

federal providers of dental care in US

• department of federal government

• department of health and human services (HHS), National Instituites of Health (NIH), Food and Drug administration (FDA), united states public health service (PHS), centers for disease control and prevention (CDC), indian health service (IHS), administration on aging, department of justice (DOJ), bureau of labor statistics, agencies

nongovernment provider of dental care in US

• private practice

• institutions

• schools

• insurance based models

state providers of dental care in united states

• department of state

• state prisons

• community clinics

• schools

department of health and human services (HHS)

• federal influence

• largest grant-making agency in the federal government that oversees national health programs and agencies

• works closely with state and local governments

• ex: school based sealant programs using federal grants to deliver services (state run but funded federally)

national institute of health (NIH)

• federal agency

• the federal government’s medical research institution

• research conducted within bethesda, maryland facilities and coordinates other research projects across the US

• national instituites of dental and craniofacial research (NIDCR)

food and drug administration (FDA)

• federal agency

• established in 1906 and headquartered in Rockville, Maryland

• regulates

  • dental materials

  • dental equipment

  • dental medicine

  • over the counter dental care products

centers for disease control and prevention (CDC)

• federal agency

• health surveillance

• prevent and monitor outbreaks

• oral health division

  • focuses on prevention

  • community water fluoridation

US Public Health Service (USPHS)

• is part of HHS and includes the Commissioned Corps and agencies dedicated to protecting and advancing health.

• federal influence

• improve and advance the health of all Americans

• US surgeon general directs

• RDH can work as a commissioned officer

medicare

• title XVIII

• federal agency - part of centers for medicare and medicaid (CMM)

• federal insurance programs from trust fund for senior citizens over 65

• generally does not fund dental care but may reimburse for hospital procedures in some instances. primarily pays medical bills

medicaid

• title XIX

• federal agency - part of centers for medicare and medicaid (CMM)

• publicly-funded insurance program for low income and populations with disabilities, aged, blind, and members with dependent children

• includes dental for children and adults in some states

CHIPS

• federal agency - part of centers for medicare and medicaid (CMM)

• the largest effort by congress since medicaid to provide health insurance to vulnerable children throughout US

• enacted as part of balanced budget act of 1997

• entitles states to allot federal funds to purchase child health assistance; 30% higher share of program cost than medicaid

• provides health coverage for eligible children whose families do not qualify for medicaid but may not afford private coverage

federally qualified health centers (FQHC)

• Centers are community-based health centers that receive federal support to provide primary care in underserved areas and to people with limited access.

• serve patients regardless of ability to pay, use sliding-fee arrangements, and often provide care through an interprofessional model.

• Dental services may be available depending on the center.

surgeon general and public health agencies

• is the nation's leading spokesperson on public health and leads the USPHS Commissioned Corps.

• reports bring attention to major health issues and synthesize evidence to inform public-health action.

• Agencies collect data, conduct research, set or implement standards, fund programs, and support access and prevention.

HIPPA

• The Health Insurance Portability and Accountability Act establishes protections for individually identifiable health information.

• It requires covered entities and business associates to protect privacy and security and limits permitted uses and disclosures.

• In practice, dental personnel should access only information needed for their role, use secure communication and records, and disclose information only as permitted or authorized

world health organization

• has identified profound oral health disparities that may relate to socioeconomic status, race, ethnicity, gender, or general health status

• underserved population groups are found in both develops and developing countries

• maintains statistics on prevalence of dental disease from more than 170 countries in their global oral data bank

• data on both periodontal disease and dental caries is accessible

dental therapists

• beginning in 200, alaska native tribal health organizations developed the alaska dental health therapist initiative

• new solution to address rural alaska’s dental needs

• DHAT student completes two year program and focuses on providing restorative care in patients located at remote areas under supervision of dentist

• delivery of health services use telecommunications

advanced dental hygiene practitioner (ADHP)

• proposed

• developed by american dental hygienist’s association

• masters degree

• no physical presence of dentist required for clinical care

• prevention and primary restorative focus

• state license required

direct supervision

• dentist not only decide and authorize dental hygiene treatment but must be physically on site during the delivery and, in some cases, may have to be in the room or examine patient after treatment

general supervision

• dentists prescribe and authorize dental hygiene care but do not need to by physically present on site while treatment is rendered

• generally, care is provided at a facility owned or managed by dentists or at public health clinics managed by them

dental therapists (UK)

• provide restorative care under the general supervision of dentists

• mostly found in united kingdom and in former countries of the British commonwealth such as autralia, canada, and nigeria

• referred to as school dental nurses in new zealand

dental nurses

• services include dental hygiene care but primary focus is on childrens restorative needs

• may restore both the primary and permanent dentition of children and extract primary teeth

federation dentair internationale (FDI)

• organization that represents the international community of dentists

• data bank that gathers epidemiological data and contains information about dentistry and dental team

International federation of dental hygienists (IFDH)

• represents dental hygiene organizations internationally and supports the development, recognition, education, and advancement of dental hygiene.

healthy people 2030

• national program establishes measurable US objectives that contribute to boarder goals of improving health and reducing disparities

international collaboration

• International organizations share evidence, develop policy recommendations, coordinate campaigns, and encourage countries to integrate oral health into broader health systems.

• Collaboration helps transfer effective prevention strategies, build workforce capacity, and address common risks such as tobacco use and high sugar consumption.

Premium

amount paid to maintain insurance coverage, usually monthly or annually, for coverage

Deductible

• amount an individual enrolled in an insurance plan must pay for covered services before the insurance entity begins paying

Copayment

• fixed amount paid by the patient for a service. portion of cost

Coinsurance

• percentage of the allowed charge paid by the patient.

Benefit

• amount that the insurance entity will pay for covered dental services described in its policy

• service or payment provided under the plan, subject to its rules and limits.

Explanation of Benefits (EOB)

• statement from the insurer showing how a claim was processed, what was allowed, what the plan paid, and what the patient may owe; it is not itself a bill.

PPO (Preferred Provider Organization)

• a network-based plan in which patients generally receive a higher level of benefit or lower out-of-pocket cost from participating providers, while out-of-network care may cost more

usual, customary, and reasonable (UCR) fee

• are the average dentist fee per service in the immediate local region

• what is most often charged by dental providers for a given dental or dental hygiene service

usual

• what is most often charged by dental providers for a given dental or dental hygiene service

reasonable

• indicates that the fee meets the usual and customary definition and is therefore justifiable

customary

• refers to a schedule of maximum fees charges by dental providers with similar training and service within a specific and limited geographic area as determined by the administrator of a dental plan based on submitted fees

dental billing

• bill for dental procedures utilizing a dental claim form

• use dental procedure codes (CDT codes)

• patients payment is expected after services are rendered

unsupervised, independent, and collaborative practice

• Dental hygiene practice without any supervision required from a dentist. Dental referral is necessary. In many states, a dental hygienist may practice only in certain public health settings

indirect supervision

• The dentist must be in the facility during dental hygiene treatment.

legislative branch

• creates laws for each state, including laws affecting the licensing and practice of dental hygiene

• Has two legislative bodies: the House of Representatives and the Senate

  • federal government = congress

  • state government = state legislature

• only branch that can enact statues and create/change statutory laws served to promote justice

executive branch

• enforce laws, executes or carries out laws passed by the legislature and enforces laws made by state legislature

  • federal government = president

  • state government = governor

judicial branch

• interprets the laws the legislature passes; judges do not make the laws but they interpret them

• composed of courts, interprets the laws the legislature passes but it does NOT make them

• common laws

  • federal government = federal courts

  • state government = state courts

statutory laws

• created and changed only by legislative branch

• describe the allowable scope of practice, necessary dental supervision requirements, requirements necessary to obtain a dental hygiene process, and suspension and revocation of licensure procedures.

• which is the legislature-enacted, written law which serves to promote justice

constitutional laws

• created and changed by people through their legislators

• Deals with the interpretation and implementation of a governments codified constitution

• The people, through their legislators, created it, and the people, also through their legislators, have the power to change it

• Takes precedence over both common and statutory laws

common law

• created and changed only by courts

• created through judicial decisions that in many cases other courts can change

• contains notions of common sense and precedent

administrative laws

• delegated legislative power to an administrative agency

• Refers to the body of rules, regulations, orders, and decisions created by a governments administrative agencies (dental boards)

• Legislature has the authority to say whether and when administrative agencies can develop rules and regulations

laws pertaining to dental hygiene

• The rules and regulation vary by state.

• Policies enacted at the federal level pertaining to dental insurance and Medicaid may affect practice

• Statutory laws describe the allowable scope of practice, necessary dental supervision requirements, requirements necessary to obtain a dental hygiene process, and suspension and revocation of licensure procedures

CDT codes

• are standardized procedure codes used to describe dental services on claims

• Providers are responsible for selecting accurate codes and documenting services; incorrect coding or billing for services not provided can constitute fraud.

state dental boards

• govern dental hygienists

  • with the exception of Iowa and new Mexico which are governed by dental hygiene committees

• Develop rules and regulations to interpret or further define the practice act

• Grant, suspend, or revoke licenses

• oversee licensure, scope of practice, supervision requirements, professional conduct, and disciplinary actions

• Are composed of dentists and dental hygienists

change agents

are individuals who cause social, cultural, or behavioral change, be it intentional or unintentional.

•They cannot be effective without the collaboration of others who are motivated by external and internal factors to pursue change.

•They are good at empowering others.

•They know what resources are available and know the position of those who oppose changes.

advocacy/ advocate

• Involves an individual or individuals with an issue and plan for remedy

• Is an individual or group of individuals with a common concern who join efforts to educate, promote, or lobby others who can assist with establishing policy, programs, or funding

• Usually closely related to the issues and work or serve with populations

• implement change in regard to how dental care is delivered, who is able to receive it, and how to ensure sustainability of a program. 

• Change in dental public health should be a primary concern and interest of dental hygienists.

well defined goals and role of change agent

•Catalyst

•Solution giver

•Resource linker

•Process helper

lobbying for policy change

•The attempt to influence or sway others towards a desired position or action

•"Art of the sell"

• formally seeks to influence legislators to enact desired legislation and informally to persuade others

•Most valued assets are their established relationships.

•A tool to provide advice on strategies, tactics, and procedures to maximize your effectiveness

•Provides access to those whom the change agent wants to influence

coalition building

•Cornerstones of creating successful change within a community

•organized alliance/ partnerships that function on a larger scale

•Come in a variety of forms: permanent, temporary, single, or multi-issue

•Increases the potential for success in creating policy change, increasing public knowledge, creating a network, and developing of innovative solutions to complex problems

coalition

• is an alliance of distinct organizations or people to take joint action

• Represents an array of interests and brings together organizations and individuals to build a power base that works to accomplish change in response to mutual concern       

• goals include

  • Influencing or developing public policy

  • Changing people's behavior

  • Building a health community
    
    

stakeholder

• Individuals in organization who have a particular vested interest in a specific topic, issue, or initiative

• Usually compose coalitions

barriers to change and effective advocacy

• can include competing interests, limited funding, misinformation, resistance to change, political constraints, lack of public awareness, professional divisions, and inadequate evidence or communication.

• Change is supported by strong data, clear goals, public support, credible messengers, collaboration, persistence, and a realistic plan.

• Grant writing can support programs by clearly stating the need, goals, measurable objectives, activities, budget, evaluation, and sustainability.