Principles of Dental Public Health Jessica K. Rebueno Santos, DDM, MCD Department of Community Dentistry College of Dentistry University of the Philippines Manila

Dental Public Health … is concerned with the diagnosis, prevention, and control of dental diseases and the promotion of oral health through organized community efforts. Canadian Association of Public Health Dentistry

Dental Public Health … serves the community as the patient rather than the individual, through research, health promotion, education and group dental care programs. Canadian Association of Public Health Dentistry

Key Concepts The community as the patient, rather than the individual The importance of public education, research, and program administration to control disease on a community level Addressing the impact of societal changes and the role played by various models of health care

Oral Health vs. Dental Health Oral cavity health extends beyond dental care of the teeth and supporting structures General public slower in making a connection beyond teeth and gums Oral health now known to be so influential in the general health of the body and vice versa Encourages other groups to readily join the effort in improving the public’s oral health

Dental Public Health Care decisions for the person in the chair are impacted by the larger community and the treatment setting

Dental Public Health Positions require skills in assessing and diagnosing community oral health needs; planning, implementing and evaluating community-based oral health programs; providing educational services; applying research; using epidemiology; formulating policy; advocating; and understanding the organization of health care.

Competencies for Dental Public Health Practitioners Advocate/change agent Health educator Clinician Consultant Researcher Administrator

Essential Public Health Services to Promote Oral Health in the U.S. Assessment A. Assess oral health status and needs B. Analyze determinants C. Assess the fluoridation status D. Implement an oral health surveillance system Policy Development A. Develop plans and policies through a collaborative process B. Provide leadership C. Mobilize community partnerships Assurance A. Inform, educate and empower the public B. Promote and enforce laws C. Link people to needed population-based oral health services D. Support services and implementation of programs E. Assure that the public health and personal health work force F. Evaluate effectiveness, accessibility, and quality G. Conduct research and support demonstration projects

Assessment A. Assess oral health status and needs so that problems can be identified and addressed. B. Analyze determinants of identified oral health needs, including resources. C. Assess the fluoridation status of water systems, and other sources of fluoride. D. Implement an oral health surveillance system to identify, investigate, and monitor oral health problems and health hazards.

National Oral Health Surveillance System Oral Health Indicators Dental Visit. Adults aged 18+ who have visited a dentist or dental clinic in the past year.  Teeth Cleaning. Adults aged 18+ who have had their teeth cleaned in the past year (among adults with natural teeth who have ever visited a dentist or dental clinic).   Complete Tooth Loss. Adults aged 65+ who have lost all of their natural teeth due to tooth decay or gum disease.   Lost 6 or More Teeth.  Adults aged 65+ who have lost six or more teeth due to tooth decay or gum disease.   Fluoridation Status. Percentage of people served by public water systems who receive fluoridated water.  Caries Experience. Percentage of 3rd grade students with caries experience, including treated and untreated tooth decay.   Untreated Tooth Decay. Percentage of 3rd grade students with untreated tooth decay.  Dental Sealants. Percentage of 3rd grade students with dental sealants on at least one permanent molar tooth.   Cancer of the Oral Cavity and Pharynx. Oral and pharyngeal cancer comprises a diverse group of malignant tumors that affect the oral cavity and pharynx (mouth and throat).   This system was developed with the collaboration of the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Dental Directors (ASTDD). Page last reviewed: January 23, 2008 http://www.cdc.gov/nohss/

Policy Development A. Develop plans and policies through a collaborative process that support individual and community oral health efforts to address oral health needs. B. Provide leadership to address oral health problems by maintaining a strong oral health unit within the health agency. C. Mobilize community partnerships between and among policy makers, professionals, organizations, groups, the public and others to identify and implement solutions to oral health problems.

Assurance A. Inform, educate and empower the public regarding oral health problems and solutions. B. Promote and enforce laws and regulations that protect and improve oral health, ensure safety, and assure accountability for the public's well-being. C. Link people to needed population-based oral health services, personal oral health services, and support services and assure the availability, access, and acceptability of these services by enhancing system capacity, including directly supporting or providing services when necessary. D. Support services and implementation of programs that focus on primary and secondary prevention. E. Assure that the public health and personal health work force has the capacity and expertise to effectively address oral health needs. F. Evaluate effectiveness, accessibility, and quality of population-based and personal oral health services. G. Conduct research and support demonstration projects to gain new insights and applications of innovative solutions to oral health problems.

Defining a Public Health Problem A condition or a situation that is a widespread actual or potential cause of morbidity or mortality A perception on the part of the public, the government, or public health authorities that the condition is a public health problem

Quiz Is dental caries a public health problem in the Philippines? Why or why not. Discuss at least 3 possible reasons why dental caries remains as the most prevalent oral health problem among Filipinos. What are the social determinants of dental caries in the Philippines?

Question How come caries-control among children has been successful in other countries but not in the Philippines?

Global Goals for Oral Health for the Year 2000, Established by the Federation Dentaire Internationale and the World Health Organization, 1982. 50% of 5- to 6-year-olds will be caries-free. The global average will be no more than 3 DMF teeth at age 12. 80% of the population should retain all their permanent teeth at age 18. A 50% reduction in present levels of edentulousness at age 35 to 40 will be achieved. A 25% reduction in present levels of edentulousness at age 65 and over will be achieved. A database will be established for monitoring changes in oral health.

Principal diseases of the mouth Dental caries Periodontal disease Oral cancer All chronic diseases that are lifestyle-dependent.

Lifestyle choices to Maintaining Oral Health Diet low in refined sugars Regular effective oral hygiene (Fluoride) enhancement of anti-caries agents Avoidance of tobacco Moderation in alcohol consumption

Factors that INCREASE Oral Disease Consumerism Conflicting messages encouraging least healthy options Commercialism Debts from foreign aid Inappropriate health service provision

Ottawa Charter for Health Promotion, 1987 New health promotion approaches Emphasize public policy and The creation of healthy environments Supporting the production and availability of healthy products Facilitating healthy behavioral options

Goals of public health Knowledge and understanding of health problems and their causes Technical capability to deal with the problems A sense of values that the problems matter and political will

Assignment 2 Differentiate the following: High Risk vs. Population Approach at preventing diseases Normative need as compared to Perceived need Impairment, Disability and Handicap. Morbidity versus Mortality

Optimum oral health Ability to chew and eat the full range of foods native to the diet To speak clearly To have a socially acceptable smile and dentofacial profile To be comfortable and free from pain To have fresh breath * Varies with age, sex and culture

Purposes of planning To match the limited resources with many problems To eliminate wasteful expenditure or duplication of expenditure To develop best course of action to accomplish a defined objective

Stages of planning Situation analysis Problem identification and formulation of objectives Formulation and analysis of alternative strategies Identification of special efforts Strategy selection Program formulation

References Guidelines for State and Territorial Oral Health Programs by Association of State and Territorial Dental Directors (ASTDD), June 2007. (www.astdd.org) Concepts in Dental Public Health by Jill Mason, 2004. GM Gluck and WM Morganstein. Jong’s Community Dental Health. 4th ed. Mosby, 1998. BA Burt and SA Eklund. Dentistry, Dental Practice and the Community. 4th ed. WB Saunders Co., 1992 Pine, Cynthia M. Community Oral Health. Reed Educational and Professional Publishing Ltd, 1997.