DHY 206 Introduction to Community Oral Health

DHY 206

Module 1: Introduction to Community Oral Health

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Public Health

• Science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts

• Public health is people’s health

• Concerned with 4 broad areas

• Lifestyle and behavior

• Environment

• Human biology

• Organization of ehealth programs and systems

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Core Functions of Public Health

• Assessment
• Assurance
• Serving all function: Research for new innovations
• Policy development

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Public Health Goals

• Prevent epidemics and the spread of disease
• Protect against environmental hazard
• Prevent injuries
• Promote and encourage healthy behaviors
• Respond to disasters and assist communities in recovery
• Assure the quality and accessibility of health services

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Essential Public Health Services

• Monitor health status to identify community health problems
• Diagnose and investigate health problems and hazards in the community
• Inform, educate and empower the community about health issues
• Mobilize community partnerships to identify and solve health problems
• Develop policies and plans to support individual and community health efforts
• Enforce laws and regulations that protect the public’s health and ensure safety  
• Ensure a competent public health and personal health care workforce
• Link people to needed personal health services and ensure the provision of health care when otherwise unavailable
• Evaluate effectiveness, accessibility, and quality of personal and population-based health services
• Conduct research for new insights and innovative solutions to health problems

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Public Health Problems

• Diseases caused by the pollution of the country’s air and water systems
• Chronic disease of the expanding population of older adults
• Inadequate funding for dental disease in indigent children
• Increase in violence among youth
• A condition or situation that is a widespread actual or potential cause of morbidity or mortality
• An existing perception that the condition is a public health problem on the part of the public, government, or public health authorities

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Public Health Solutions

• Immunizations
• Tobacco cessation programs
• Fluoridation of drinking water
• Seat belts and airbags in cars
• Attainable regardless of socioeconomic status
• Effective immediately upon application
• Inexpensive and within the means of the community

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Guiding Principles

• Characteristics of public health solutions

• Not hazardous to life or function

• Effective in reducing or preventing the targeted disease or condition

• Easily and efficiently implemented

• Potency maintained for a substantial time period

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Great Public Health Achievements of the 20th-21st Century

• Vaccinations
• Workplace safety
• Motor vehicle safety
• Control of infectious disease
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Community water fluoridation
• Recognition of tobacco as a hazard

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CDCP Public Health Accomplishments (2009-2012)

• Improve health security at home and around the world
• Better prevent the leading causes of illness, injury, disability, and death
• Strengthen public health and health care collaboration

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Dental Public Health

• Dental public health focuses on oral health care and the education of a population, with an emphasis on the utilization of dental hygiene services

• Goals to be met to improve dental public health:

• Earn support from the public

• Earn support form the policy makers

• Earn support from the dental community

• Ensure recruitment and professional development of dental public health personnel

• Ensure collaboration with colleagues

• Dental public health is defined by the American Board of Dental Public Health and recognized by the American Dental Association as:

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

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Dental Disease as a Public Health Problem

• Dental caries
• Periodontal disease
• Oral cancer

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Factors Affecting Dental Public Health

• Access to care
• Infrastructure of dental care delivery
• Dental workforce and practice of dental hygiene
• Oral health disparities
• Dental care needs of the aging population
• Malpractice
• Dental insurance

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Community Oral Health

• Examines the needs of individuals within a community and developing programs to meet those needs

• Needs assessment

• Assess, plan, implement, and evaluate

• Differs from the private practice model

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Preventive Modalities

• Dental hygiene therapies
• Community water fluoridation
• Fluoride therapies
• Sealants
• Xylitol
• Nutritional counseling
• Tobacco cessation and oral cancer screenings
• Athletic mouthguards
• Oral health education and promotion
• Alternative restorative treatment (ART)

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Comparison of Components in Private Practice & Public Health

• Patient

• Exam

• Diagnosis

• Treatment planning

• Treatment

• Fee/payment

• Patient evaluation

• Documentation

• Community

• Survey

• Analysis

• Program planning

• Program implementation

• Budget/financing

• Program evaluation

• Documentation

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New Topics in Health People 2020

• Adolescent health
• Dementia (including Alzheimer’s Disease)
• Early and middle childhood
• Genomics
• Global health
• Healthcare-associated infections
• LGBT Health
• Preparedness
• Older adults
• Sleep health
• Social determinants of health

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Government Agencies

• Federal

• Departments of the federal government

• State

• Departments of state

• State prisons

• Community clinic

• Schools

• Local

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Strategic Plan of HHS

• Goal #1

• Reform, strengthen, and modernize the nation’s healthcare system

• Goal #2

• Protect the health of americans where they live, learn, work, and play

• Goal #3

• Strengthen the economic and social well-being of Americans across the lifespan

• Goal #4         

• Foster sound, sustained advances in the sciences

• Goal #5         

• Promote effective and efficient management and stewardship

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Oral Health Service Delivery- Global

• Varies per country based on the type of national system

• Socialized medicine model

• National healthcare model

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Professional Associations

• American Dental Hygienists Association (ADHA)
• American Public Health Association (APHA)
• American Association of Public Health Dentistry (AAPHD)
• American Dental Association (ADA)

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Roles of the Dental Hygienist

• Service provider/clinician  
• Health educator/wellness promoter
• Consultant/resource person
• Consumer advocate/change agent
• Researcher
• Administrator/manager

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Role of the RDH in Public Health

• Employment within programs that include:

• Health promotion

• Community disease prevention

• Provision of dental hygiene care to selected groups of people

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Dental Hygiene Workforce

• Approximately 207,900 jobs in 2016
• Employment expected to grow by 28%between 2012-2025 (much faster than the average for all occupations)

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Access to Services

• Regulatory issues

• Labor/workforce issues

• Supply/demand

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New Workforce Models

• Collaborative efforts of multiple stakeholders:

• Professional communities

• Education

• Department of labor

• Legislators

• Health service agencies

• Local, state, federal agencies

• Professional research entities

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New Models of Dental Providers

• Advanced dental hygiene practitioner (ADHP)

• American Dental Hygienists’ Association

• Master’s degree

• Dentist does not need to be physically present for clinical care

• Prevention and primary restorative

• State DH license required

• Dental therapists (DT)

• Dental therapists will be able to administer a number of services without the dentist onsite, but all restorative services, extreations, and services that are more involved would require the presence of a dentist

• Alaska dental therapist (DHAT)

• No degree quired

• United states public health service

• Focus is restorative

• Dentist does not need to be physically present for clinical care

• Community dental health coordinator (CDHC)

• American Dental Association

• No degree required

• Dentist must be present for clinical care

• Prevention is the focus

• No state license needed

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Summary

• Community health models focus on targeted populations rather than individuals
• Collaborative efforts of local, state and federal agencies and community partners are key for successful programs to address the community’s needs
• There will be an expansion of need for dental hygienists as a collaborative partner in healthcare

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