1. Community
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2. Sealants Primary preventative strategy
6-8 year olds and year olds (first and second year molars erupting)
Sealants
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3. Educational programs can be developed and presented in many different ways
Best to help people prevent oral disease
Helps people make decisions for their health and the best way to prevent disease
The community needs to have a positive attitude and interested in learning about ways to change
Oral Health Education
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4. Mouthrinses tend to be the CHEAPEST and best way to reach a large population if decay is a problem
.2% NaF is the best type of mouthwash to use
Mouthrinses
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5. Index – a scale having upper and lower limited, with values corresponding to specific criteria
Reversible – conditions that can be changed back to health
Irreversible – conditions can not be changed (caries)
Useful index is needed! Simple, understood, valid, etc.
Index
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6. Standard teeth that can be used to determine periodontal health
Tooth numbers – 16,21,24,36,41,44
Ramfjord Index Teeth
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7. DMFT Total caries experience (past and present) 28 teeth Cumulative
Irreversible
D = decay AND restoration (because its from decay)
M = extraction DUE TO CARIES, tooth that needs to be extracted due to caries, or nonrestorable
F = filled teeth, temporary restorations, defective restorations (NOT INCLUDING BONDING OR COSMETIC RESTORATIONS FOR PURPOSES OTHER THAN DECAY)
TEETH NOT COUNTED
Third molars, unerupted teeth, congenitally missing, teeth extracted. Primary teeth that remain after permanent successive tooth erupted
DMFT
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8. Scoring of DMFT D + M + F = 3 + 1 + 6 = 10
DMFT can be averaged for a group and can help indicate the treatment needs
FOR A GROUP:
D = 175. M = 55. F = 18. DMFT = 248
D / DMFT = 175 / 248 = 0/7 or 70% of teeth in the group need restorations
Scoring of DMFT
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9. DMFS Each tooth has 5 surfaces
Multiply the number of teeth included by 5 to get the total surfaces
Count the individual surfaces for each of D, M and F
ALL OTHER ARE THE SAME AS DMFT
DMFS
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10. Primary decayed, needs to be extracted, or filled.
For primary teeth – use lower case letters – deft, defs
Primary canines and molars
Primary decayed, needs to be extracted, or filled.
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11. PSR Periodontal status
Motivator when they know the numbers of their PSR
Special probe – 3.5,5.5, 8.5, 11.5
0.5mm ball working tip – increases comfort
Colored area is the
PSR
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12. 0 – no calculus, no defective margins, no BOP, colored area completely visible
TREATMENT – plaque and prevention
1 – colored band is visible, no calculus, no defective margins, BUT BOP
2 – colored band visible, CALCULUS, DEFECTIVE MARGINS, BOP
TREATMENT – plaque, prevention, remove calculus, fix defective
3 – colored area partially visible, sulcus is
TREATMENT – comprehensive perio assessment, treatment recommendations consult
4 – colored area NOT visible, sulcus is greater than 5.5mm
TREATMENT - same
PSR
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13. When you see a *
Mobility, furcation, recession, mucogingival defect
PSR *
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14. PSR No teeth are marked with an X
Feel free to write other general statements
PSR
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15. Community Periodontal Index
CPI
Developed by W.H.O
Almost like PSR but sextants MUST HAVE 2 FUNCTIONAL TEETH FOR ITS OWN SEXTANT
10 teeth are examined: 1st and 2nd molars in each posterior sextant, tooth 11 and tooth 31
To look at periodontal status of populations
If no index teeth are present in a sextant, all the other teeth in the sextant are assessed
8’s not included UNLESS THEY ARE USED AS 7’s
Adults 20+
0 = healthy
1 = bleeding
2 = calculus
3 = 4-5mm pocket
4 = 6mm or more pocket
Community Periodontal Index
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16. Plaque index PI – Sillness and Loe
Assesses thickness of plaque at cervical margin (gingival third)
4 areas – mesial, distal, facial and lingual
Each tooth score is an average of these four areas
Entire mouth or selected areas
1. Air dry
2.With probe pass tip along gingival third
3.Record the 4 numbers per each tooth
4.Average the four number
5.Teeth can be averaged together to get a score for group or entire mouth
0 = no plaque
1 = light
2 = moderate
3 = heavy
Plaque index
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17. Score for PI 0 = excellent 0.1-0.9 = good 1.0-1.9 = fair
2.0 – 3.0 = poor
Score for PI
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18. PCR Plaque Control Record O’Leary plaque index
Presence of plaque on individual tooth surfaces so client can visualize
All teeth, EXCEPT tooth colored restorations
4 or 6 surfaces can be assessed for each tooth
Disclosing agent used for gingival third of the tooth
Record plaque with a “–” (dash) or coloring the section of the chart used
10% or less is an ideal goal
Total number of teeth with plaque/6 X number of teeth present X 100 = % score
( **6 is for the 6 surfaces)
PCR
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19. Location, number and percentage of biofilm free surfaces
Bleeding can be noted
By dash or coloring in the section as well
Plaque Free Score
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20. Simplified Oral Hygiene Index (OHI-S)
Looking at the extent the teeth are covered with debris or calculus
Two parts – simplified debris index (DI-S) and simplified calculus index (CI-S). These two parts can be combined to form the simplified oral hygiene index (OHI-S)
Includes stain as well
One surface of six specific teeth are used:
16F, 11F, 26F, 36L, 31F, 46L
Simplified Oral Hygiene Index (OHI-S)
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21. Simplified Debris Index
DI – S
Air dry tooth, run probe along tooth surface, assign tooth a score based on how much debris covers the tooth, average the 6 teeth for a total score.
0 = none
1 = soft debris covering no more than 1/3 of surface, OR stain
2 = soft debris covering more than 1/3 of surface
3 = soft debris covering more than 2/3 of tooth
Simplified Debris Index
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22. Simplified Calculus Index
CI – S
Explorer/probe used to look at supragingival calculus
Also subgingival calculus
Record hard calculus
One code per tooth
Average codes for 6 teeth together for final score
Dry tooth, assess for sub and supra, assign score and average
0 = no calculus
1= calculus supra covering not more than 1/3
2 = supra covering more than 1/3 OR flecks of subgingival calculus around cervical portion
3 = supragingival covering more than 2/3 or continuous heavy and around cervical
Simplified Calculus Index
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23. Score 0 = excellent 1.1-0.9 = good 1.0-1.9 = fair 2.0-3.0 = poor
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24. Simplified Oral Hygiene Index
OHI – S
The rating and scores for DI-S and CI-S are the same. To calculate the OHI-S score you need to add these both together
Score:
0= excellent
= good
= fair
= poor
Simplified Oral Hygiene Index
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25. Patient Hygiene Performance
Following ORAL HYGIENE EDUCATION
6 teeth selected, each tooth is divided into 5. If plaque = 1 and if no plaque = 0
Patient Hygiene Performance
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26. Gingival Bleeding Is there gingival inflammation?
30 proximal areas for all teeth in the mouth
UNWAXED dental floss used
STEPS: floss up and down one stroke, new floss for each area, allow 30 seconds for each section to see if blood shows up
Bleeding = disease
Gingival Bleeding
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27. Gingival Index Gingivitis – color and firmness of tissue and if BOP
Each tooth examined at M, L, D, F (or buccal). Probe is used to press on gingiva and near the sulcus
0 = normal
1 = mild inflammation NO BOP
2 = moderate, BOP
3 = severe, ulceration and spontaneous bleed
Each surface given score, total score, divided by four
0 = excellent
0.1 – 1.0 = good
= fair
= poor
Gingival Index
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28. Eastman Interdental Bleeding Index
EIBI
Assess inflammation at interdental area for bleeding
Each proximal are examined
TRIANGULAR WOODEN INTERDENTAL CLEANER
Score – number of bleeding areas as a percentage or number
Insert gently, remove it, depress papilla 1-2 mm, insert and remove 4 times per area. Record if it bleeds
Eastman Interdental Bleeding Index
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29. Deans Fluorosis Smooth surface enamel of all teeth looked at
0 = normal
1 = questionable – slight changes
2 = very mild – opaque, white areas over less than 25% of labial surface
3 = mild – opaque areas more extensive but cover less than 50%
4 = moderate – significant wear and possible brown spots
5 = severe – widespread and severe
Deans Fluorosis
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30. RESEARCH
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31. Scientific Method Formulation of a problem Formulation of hypothesis
Collecting the data
Analysis of interpretation of results
Presentation of the results
Conclusion
Scientific Method
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32. The Problem Looking at anything that you want to find out Example:
Which areas of the mouth have more plaque
What age groups typically have more plaque
What if a child does NOT have access to fluoride
The Problem
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33. Other Hypothesis – reflects the question of research
Hypothesis means – taking a guess
Collecting the data – use calibrated (each researcher has to follow certain standards), validated and reliable data
Validity – instrument measuring something
Reliability – interrater means 2 or more examiners agree and intrarater means one examiner being consistent with previous recordings from another examiner
Other
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34. Population Entire group or unit
Parameter – looks at numeric characterises of population
Target population – certain population where information is being collected
Sample – portion from population
Statistics – numeric
Pilot study – preliminary study in preparation for a MAJOR study
Random sampling – each member has a chance
Stratified sampling – random selection from 2 or more subdivisions
Systematic sampling – selection of a subject including every “5th person”, or “3rd person” etc.
Purposive sampling – sample through personal judgement, biased
Convenience sampling – whoever is available
Experimental group – sample group receiving experimental treatment
Population
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35. Continued Control group – does NOT receive any experimental treatment
Independent variable – treatment imposed on the experimental group
Dependant variable – caused by INDEPENDENT variable
Data – information collected from measurements during research phase
Discrete data – limited set of values (qualitative)
Continuous data – continuous range of variable measurements (quantitative)
Continued
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36. Descriptive statistics – describe and summarize
Descriptive statistics – describe and summarize. Communicate the results
Inferential statistics – apply the information from the sample to a larger population
Mean – average of the group (sum/number of items)
Median – exact middle score
Mode – most frequently
Range – highest and lowest values, looking at the difference
Variance – method of measuring the way in which individual variables are located around the MEAN
Standard deviation – positive square of variance
Data Analysis
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37. Example
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38. Negative correlation with variables – shows inverse (opposite) relationship between variables
Positive correlation with variables – both variables increased (or decrease)
Correlation
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39. Example
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40. Bar Graph
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41. Data that is continuous
Frequency Polygon
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42. Histogram Interval variables that are continuous
Equal width and the bars touch each other
Histogram
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43. Parametric Statistics
When data includes interval or ratio scales of measurement
Bell shaped curve on the graph
Parametric Statistics
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44. Non-Parametric Inferential Statistics
Nominal or ordinal scale
Qualitative
Sample size small
Common test – chi-square test
Determines whether a relationship exists between two variables
Non-Parametric Inferential Statistics
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45. Analysis of Variance Comparing MORE THAN TWO sample means
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46. T-Test Difference between two means – treatment A vs treatment B
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47. Using samples that are too small or too large can have an effect on the data
Power analysis – determining how many subjects are needed, sample size
INDEPENDENT VARIABLE
The greater the significance
Remember
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48. A 95% confidence interval means the researcher is wrong 5 times in 100 – 5% chance results are due to chance alone
Increasing the confidence interval also decreases the specificity of the data
Confidence Intervals
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49. P Value How likely the study could come to a false conclusion
Calculated according to sample size – means of the control and standard deviation of distribution
P < .05 is acceptable
P < .05 means the results were due to chance only five times in 100
P values of .01, .001 and lower increase significance of the study
P Value
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50. Results from data analysis determines whether study shows significance and conclusion
Type I error – results when a relationship exists when it does not
Type II error – hypothesis accepted but actually false (no relationship exists when it actually does)
Hypothesis
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51. Abstract Study’s purpose, methods, materials and results
Provide reader with the overview of the study
200 words
Abstract
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52. Techniques used to gather information about the populations studied
Must be complete enough to get proper data
The number of subjects in group also important – is there enough?
Methods Materials
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53. Results How was hypothesis tested?
Statistical tests should be appropriate to study and described with graphs
Results
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54. Discussion From conclusions – what are results and outcomes?
Conclusion needs to stay if hypothesis has been rejected or accepted
What do results mean?
Is further research needed?
Any complications observed?
NEVER make statements NOT from study results
Discussion
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55. Assessment, policy development and quality assurance are very important aspects of public health
The mission of public health is to ensure the conditions in which people can be health
Community health is all affected by changes
Roles of public health:
Collect, analysis and application of information
Deliver public health programs
Work with communities to form partnerships
Determine health concerns
Assessment
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56. Evaluate effectiveness, accessibility and quality of population based and personal oral health services
Health status can be influenced on so many things such as: host factors, agent factors and environmental factors
Must know basics of epidemiology:
Epidemiology – study of distribution and determinants of health related states and events in specified populations and the application of this study to the control of health problems
Follow up
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57. Determinants of Health
Factors that interact to create circumstances and produce specific health conditions
Physical
Biologic
Social
Cultural
Spirtual
Inherited – factors you are born with
Acquired – factors obtained after birth
Determinants of Health
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58. Systems orientation to health – approach is holistic, complex, and interactive
Today
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59. Mandala of Health Developed by Hancock
Circular pattern symbolizing symmetry and wholeness
Integration of mind, body, and spirit at centre.
Mandala of Health
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60. Factors Factors that influence health: Psychosocioeconomic environment
Physical environment
Human biology
Personal behaviour
Factors
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61. Remember that oral health is directly related to our overall health
Oral health can be thought of as a second tier
ADPIE – all of it ties in 
Oral Health
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62. Functions You want to fulfill your mission and goals
Programs are for preventing oral disease
Practical, safe, acceptable, effective and efficient
Functions
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63. Methods of Dental Public Health
Examination vs Survey – collects individual data during exam phase of care
Public health provider – assess extent of disease in a community on basis of descriptive information (survey data, epidemiological assessments)
Diagnosis vs Analysis – decisions based upon standard statistical methods (indexes and guidelines)
Dental index quantifies the magnitude of disease measured
Specific criteria
Treatment Planning vs Program Planning – conveyed to community partners vs individual clients
What is the problem and how many people are affected?
Evaluation vs Appraisal – worth of the program
how well did the program achieve the goals?
Evaluation is on going and at the end of treatment phase
Methods of Dental Public Health
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64. Methods Goals – broad statement of what changes will take place
Objectives – specific, figure out what needs to be established for the program to be successful
Who pays? Public, volunteers or both?
Methods
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65. Types of Community Programs
Primary – sealants, OHE
Secondary – community treatment programs
Tertiary - dentures
Types of Community Programs
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66. Planning and Implementing
Planning - forming key partnerships with the community
Implementing – collecting data from sources, analyzing data, communicating and making public the findings
Planning and Implementing
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67. Quantitative – objective and measureable, quantity or numbers
Qualitative – cannot be measured in numbers, personal interviews
You need to analyze and interpret data – make it simple and then summarize the findings for the meaning and significance
DO NOT BE BIASED
Types of Data
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68. Descriptive – description, documentation, analysis and interpretation
Analytic – identify the cause, disabilities, injuries and deaths
Experimental – determines the effectiveness of altering forces
Randomized control trials – intervention introduced and subjects followed and randomly assigned
Cohort study – study starts in the middle. Following someone who has started a risk factor for a disease (too much sun, smoking, stress) and follow to see when and IF they develop disease
Case control study – starts at the end (retrospective) find subjects that have the disease already and those that don’t.
Studies
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69. Think fluoride supplement programs – the patient needs to be compliant with supplements so water fluoridation SO MUCH EASIER and then expense
Fluorosis has increased but decay has DECREASED (which is good)
Varnishes are best to prevent root surface caries, great for children and in a hospital setting
Shown to reduce caries in children
Compliance
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70. Great as prevention, used to protect permanent molars from decay
Low income populations may not have access to this
Sealants
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71. References Mosbys Comprehensive Review of Dental Hygiene
Graphs and images from google images
Wilkins Text
References
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