1. 1 COMMUNITY DENTAL HEALTH Algonquin College Janet Ladas

2. 2 HISTORY OF PUBLIC HEALTH 1867- British North American Act - Colonies came together to control disease1867- British North American Act - Colonies came together to control disease 1870 - Ontario Public Health Act - Disease based1870 - Ontario Public Health Act - Disease based 1875- The English Public Health Act (Britain) - Provinces modeled after this Act - People demanded treatment1875- The English Public Health Act (Britain) - Provinces modeled after this Act - People demanded treatment

3. 3 HISTORY OF PUBLIC HEALTH 1974- Lalonde Report “A New Perspective on Health1974- Lalonde Report “A New Perspective on Health of Canadians” - Focus on health promotion 1983 - Ontario Health Protection and Promotion Act - Legislates all Ontario Health Departments and Health Care and Social Service care providers1983 - Ontario Health Protection and Promotion Act - Legislates all Ontario Health Departments and Health Care and Social Service care providers - Prevention through organization and delivery of public health programs and services

4. 4 HISTORY OF PUBLIC HEALTH 1986- Two landmark documents that affected Ontario health policies1986- Two landmark documents that affected Ontario health policies - 1.”Achieving Health For All: A Framework for Health Promotion” 2.”The Ottawa Charter on Health Promotion” 2.”The Ottawa Charter on Health Promotion” 1987 - Three important Ontario reports released by John Evans, Robert Spasoff and Steve Podborski - further impacted on health promotion policies1987 - Three important Ontario reports released by John Evans, Robert Spasoff and Steve Podborski - further impacted on health promotion policies - lead to formation of Premiers Health Council

5. 5 HISTORY OF PUBLIC HEALTH 1993- December 31 Proclamation of –1993- December 31 Proclamation of – The Regulated Health Professionals Act The Regulated Health Professionals Act

6. 6 CRITERIA FOR PUBLIC HEALTH DECISIONS 1. Disease or other threat to health is widespread 2. Knowledge exists on how to prevent or cure the condition 3. Such knowledge is not being applied W.H.O. DEFINITION OF HEALTH “A state of complete physical / mental and social well-being and not merely the absence of disease”

7. 7 CORE FUNCTIONS OF PUBLIC HEALTH CORE FUNCTIONS OF PUBLIC HEALTH (Applied to D.I.S. and Screening) ASSESSMENT  Data analysis  Statistics on dental health status/needs POLICY DEVELOPMENT  Evidence-based decision making  Set goals and objectives “More children and youth have healthy teeth and gums and fewer have dental caries” (M.O.H.)

8. 8 CORE FUNCTIONS OF PUBLIC HEALTH CORE FUNCTIONS OF PUBLIC HEALTH (Applied to D.I.S. and Screening) ASSURANCE OF SERVICES Provide services-Municipality Provide funding-Province  Cost verses results  Assure access to care (funding)  Intense follow-up to assure care

9. 9 COMMUNITY PREVENTION PROGRAMS PREVENTION – PRIMARY GOAL  PRIMARY PREVENTION - most effective - prevents disease before it occurs – fluoridization / immunization, diet, physical activity

10. 10 COMMUNITY PREVENTION PROGRAMS PREVENTION – PRIMARY GOAL  SECONDARY PREVENTION - treats disease after it occurs - promptly - reduce prevalence - shorten duration - screening / referrals - early & accurate diagnosis

11. 11 COMMUNITY PREVENTION PROGRAMS PREVENTION – PRIMARY GOAL  TERTIARY PREVENTION - limits or rehabilitates a disability from disease – e.g. - prostheses provided - reduce complications * COMMUNITY PREVENTION PROGRAMS USED ONLY WHEN SHOWN TO BE EFFECTIVE BY WELL- DESIGNED CLINICAL STUDIES AND EVIDENCE- BASED RESEARCH

12. 12 WORLD HEALTH ORGANIZATION  Est. April 7/48 = World Health Day ACTIVITIES – Global Based (200 Countries)  Maintains Global Oral Data Bank  Collects information and develops methods for that collection (indices)  Monitors oral disease changes  Develops and tests epidemiological methods

13. 13 WORLD HEALTH ORGANIZATION ACTIVITIES  Maintains Country Profile development (information on oral disease and services, tobacco use, sugar consumption, fluoride/fluoridization)  Implements and evaluates community preventive programs (affordable oral care)  Public education / health promotion

14. 14 WORLD HEALTH ORGANIZATION ACTIVITIES  Advocacy and legislation promotion  Information dissemination (41 W.H.O. centers worldwide)

15. 15 WORLD HEALTH ORGANIZATION YEAR 2000 GOALS By the age of: 5-6 - 50% should be caries free 12- DMFT should be less than 3 18- 85% should have retained all their teeth 34-44- a 50% reduction in the number of persons with no teeth 65 plus- a 25% reduction in the number of persons with fewer than 20 teeth W.H.O. is currently developing a new set of global goals for “2010”

16. 16 DENTAL PUBLIC HEALTH = PEOPLE’S HEALTH  Science and art of preventing and controlling dental disease on a community basis (not individual)  Promotes dental health through organized community efforts  Educates the public using applied dental research (evidence-based)  Develops resources  Funded by government

17. 17 WHAT DENTAL PUBLIC HEALTH IS NOT:  “Welfare Dentistry”  Just conducting surveys  Just fluoridation  Independent practice  Provider of last resort

18. 18 TEN GREAT PUBLIC HEALTH ACHIEVEMENTS 1. Control of infectious diseases 2. Decline in death from heart disease and stroke 3. Family planning 4. Water Fluoridization 5. Healthier mothers and babies

19. 19 TEN GREAT PUBLIC HEALTH ACHIEVEMENTS 6. Motor vehicle safety 7. Recognition of tobacco health hazards 8. Safer and healthier foods 9. Safer workplaces 10. Vaccination

20. 20 CURRENT DENTAL PUBLIC HEALTH PRACTICE 1. Water Fluoridization 2. Prevention of oral cancer 3. Reduction of dental problems 4. Education 5. Nutrition 6. Injury Prevention 7. Research and development

21. 21 1. WATER FLUORIDIZATION 1901-08Dr. Fredrick McKay observed “Colorado Brown Stain” (Motteling and brown opacities of the teeth – less caries) 1920Common link – shared water source – water analysis showed nothing 1925McKay advised using water from outside source – resulted in less motteling

22. 22 1. WATER FLUORIDIZATION 1930Improved water analysis method showed correlation between increased fluoride resulted in more motteling then termed “Dental Fluorosis” 1931Dr. H. Trendley Dean Goal: to define the minimal level of fluoride to inhibit caries without Fluorosis - developed Fluorosis index Result: caries rate down at F. Level up to 1.0 p.p.m.

23. 23 2. PREVENTION OF ORAL CANCER W.H.O. – A GLOBAL CONCERN TOBACCO CESSATION  How to reduce oral cancer  Train health care workers to look for early signs  Education of the public – advertising (causes and signs)  Involve other educators (teachers)  Public policy – taxes / bans  Individual counselling  Prevention / cessation programs  Social acceptance changes

24. 24 3. REDUCTION OF DENTAL PROBLEMS PREVENTIVE MEASURES  Sealants – effective but underused  Fluoride – variety of sources  Prophylaxis – improved access to care  Government funded programs C.I.N.O.T. / D.I.S.

25. 25 4. EDUCATION  Information / Promotion - Dental Health Month - Dental Health Week - School dental curriculum - Dental Associations (To name a few)

26. 26 5. NUTRITION  Canada Food Guide  School food policies  Food labeling

27. 27 INJURY PREVENTION  SEAT BELTS  SPORTS EQUIPMENT (MOUTHGUARDS)  BIKE HELMETS

28. 28 7. RESEARCH AND DEVELOPMENT  EPIDEMIOLOGY – study of disease and health in populations - caries control - periodontal disease - monitor disease trends - collected data analysis and dissemination

29. 29 PREVENTIVE PROPERTIES OF FLUORIDE CLASSICAL EPIDEMIOLOGICAL STUDY – SIX PRINCIPALS 1.Studied groups not individuals “Colorado Springs Community” 2.Examined “well” and “ill” people – long term residents more affected 3.Looked at relative prevalence surrounding areas studied

30. 30 PREVENTIVE PROPERTIES OF FLUORIDE CLASSICAL EPIDEMIOLOGICAL STUDY – SIX PRINCIPALS 4.Broad goal established, e.g. association between prevalence of fluorosis or caries and fluoridated and non- fluoridated areas 5.Required 2 demonstrations - association itself is dependable and predictable from population to population - other factors could not be responsible

31. 31 PREVENTIVE PROPERTIES OF FLUORIDE CLASSICAL EPIDEMIOLOGICAL STUDY – SIX PRINCIPALS 6.Support for association between fluoride and dental health is gained through additional studies FINAL CONCLUSION Water can be fluoridated to optimal level to reduce caries without increasing fluorosis

32. 32 MINISTRY OF HEALTH PROGRAM CHILDREN IN NEED OF TREATMENT C.I.N.O.T.  Dental Screening Program– 3 Hygienists High/Moderate Risk Elementary Schools - screening of selected students and data recording - intensive follow-ups and referrals - take home notice - phone contact/consultation - follow up school screening - provision of preventive services - exam, prophylaxis, sealants, fluorides

33. 33 MINISTRY OF HEALTH PROGRAM CHILDREN IN NEED OF TREATMENT C.I.N.O.T.  Dental Screening Program– 3 Hygienists High/Moderate Risk Elementary Schools - Dental Health Education and Promotion - clients, caregivers, school staff - resource person - for students / caregivers - in the community - for other health care providers Year 2000: - 60 schools screened - 1500 CINOT referrals - 480 clinic services

34. 34 TERMINOLOGY EPIDEMIOLOGY: THE STUDY OF THE AMOUNT, DISTRIBUTION, DETERMINANTS AND CONTROL OF DISEASES AND HEALTH CONDITIONS AMONG GIVEN POPULATIONS. ENDEMIC: A RELATIVELY LOW, BUT CONSTANT LEVEL OF OCCURRENCE OF A DISEASE OR HEALTH CONDITION IN A POPULATION.

35. 35 TERMINOLOGY EPIDEMIC: A DISEASE OR CONDITION CCURRING AMONG MANY INDIVIDUALS IN A COMMUNITY OR REGION AT THE SAME TIME AND USUALLY SPREADING RAPIDLY. OFTEN CALLED AN “OUTBREAK” OF DISEASE. WIDESPREAD OUTBREAKS ACROSS A REGION OR CONTINENT MAY BE TERMED PANDEMIC IN EXTENT. DISEASE RATES: THE NUMBER OF CASES OR DEATHS AMONG A POPULATION OR TARGET GROUP DURING A GIVEN TIME PERIOD, EXPRESSED AS A RATIO. RATES ARE OFTEN STATISTICALLY “ADJUSTED” TO MAKE VALID COMPARISONS ACROSS DIFFERENT POPULATIONS OR TO DETECT TRENDS WITHIN THE SAME POPULATION.

36. 36 TERMINOLOGY MORTALITY: THE RATIO OF THE NUMBER OF DEATHS FROM A GIVEN DISEASE OR HEALTH PROBLEM TO THE TOTAL NUMBER OF CASES REPORTED. MORBIDITY: THE RATIO OF “SICK” (AFFECTED) INDIVIDUALS TO WELL INDIVIDUALS IN A COMMUNITY. IT OFTEN MEASURES THE LEVEL OF NONFATAL HEALTH CONSEQUENCES (SEVERITY) OF A DISEASE OR CONDITION.

37. 37 TERMINOLOGY PREVALENCE: A NUMERICAL EXPRESSION OF THE NUMBER OF ALL EXISTING CASES OF A DISEASE OR PROBLEM IN A POPULATION MEASURED AT A GIVEN POINT OR PERIOD OF TIME. CASE RATE: FREQUENCY OF OCCURRENCE OF A CONDITION INCIDENCE: THE NUMBER OF NEW CASES OF A DISEASE IN A POPULATION OVER A GIVEN PERIOD OF TIME.

38. 38 TERMINOLOGY ETIOLOGY: THE THEORY OF CAUSATION FOR A DISEASE OR CONDITION. RISK FACTORS: CHARACTERISTICS OF AN INDIVIDUAL OR POPULATION, WHICH MAY INCREASE THE LIKELIHOOD OF EXPERIENCING A GIVEN HEALTH PROBLEM (E.G., AGE, GENDER, EDUCATIONAL LEVEL, SOCIOECONOMIC STATUS).

39. 39 TERMINOLOGY INDEX: A STANDARDIZED METHOD USED TO DESCRIBE THE STATUS OF AN INDIVIDUAL OR GROUP WITH RESPECT TO A GIVEN CONDITION. INDEXES USUALLY INVOLVE A GRADUATED SCALE FOR MEASURING THE EXTENT OF THE HEALTH PROBLEM. SURVEILLANCE: METHODS OR SYSTEMS USED TO MONITOR DISEASE AND MORBIDITY INA POPULATION PERIODICALLY OR ON AN ONGOING BASIS. IT IS AN IMPORTANT FUNCTION OF THE CENTERS FOR DISEASE CONTROL (CDC) AND HEALTH DEPARTMENTS, ETC.