Community Dentistry Years I - IV Dr David Locker Room 521 (ext 4490)

Year I: Term I Epidemiological methods Epidemiology of oral diseases Determinants of health and disease

Year I: Term II Current issues in dental health care

Year II: Term I Clinical epidemiology and critical appraisal

Year II: Term II Evidence-based care: small groups learning

Years III and IV Communication in dental practice Psychological and behavioural issues in dental practice Ethics in dentistry Jurisprudence

Years I and II Providing clinical care to patients Years I and II Providing clinical care to patients What is the evidence re: benefit? Is the evidence high quality? Is the evidence relevant?

Year 1: Fall Term Lecture 1 Year 1: Fall Term Lecture 1

Introduction to Epidemiology Nature and scope of epidemiology Contribution to dentistry and dental practice OBJECTIVES:

Two Types of Health Care 1.Treats individuals 2.With physical and psychological disorders 3.Aims to RESTORE HEALTH Clinical Practice: 1.Treats communities and populations 2.Currently healthy 3.Aims to PREVENT DISEASE and MAINTAIN HEALTH Population (Public) Health Practice:

Scientific study of the frequency, distribution and determinants of health and disease in human populations

EXPOSURES INTERVENTIONS EXPOSURES INTERVENTIONS OUTCOMES Causation

All decisions that health professionals make health professionals make involve assumptions about causal mechanisms

Aetiology:Risk factorsDisease Therapy:TreatmentImprovement in patients condition Health serviceHealth servicesImproved delivery:community health Aetiology:Risk factorsDisease Therapy:TreatmentImprovement in patients condition Health serviceHealth servicesImproved delivery:community health Causal Relationships in Health Care

Comprehensive understanding of oral health and disease Understanding of scientific methods Causes of oral disease Evaluation of interventions Role in decisions re: diagnosis and treatment for the individual patient

SCIENTIFIC METHODS CRITICAL APPRAISAL EVIDENCE BASED CARE

Characteristics of Epidemiology 1.Science 2.Populations and population sub-groups 3.Prevalence, incidence and risk

Science A systematic set of methods for producing knowledge about events and their relationships which eliminates chance, bias and error.

Power of Epidemiology 1854London cholera epidemic 1940Fluoride and dental caries 1970US toxic shock syndrome epidemic

London cholera epidemics

Table 1: Results of Snows Investigation 61 Known to have drunk pump water 61 Known to have drunk pump water 6 Believed not to have drunk pump water 6 Believed not to have drunk pump water 6 No info 6 No info 5 In families sending to Broad St. pump for water 5 In families sending to Broad St. pump for water 3 Children attending school near pump 3 Children attending school near pump 2 No info 2 No info 73 living near Broad St. pump10 not living near pump 83 Deaths* *Out of 83 individuals who had died of the disease, 69 were known definitely or could be assumed to have drunk the pump water, 6 were believed not to have drunk it, and for 8 there was no information

Fluoride and dental caries (see attachment)

Mechanisms by which fluoride considered to inhibit dental decay 1. Pre-eruptive - reduce enamel solubility

Mechanisms by which fluoride considered to inhibit dental decay 2. Post-eruptive - promote remineralization - inhibit bacterial acids

Fluoride mechanisms Better understanding of mechanisms Debate re: modes of delivery

Toxic shock syndrome

1.Epidemiology is a logical discipline which proceeds by way of sequence of reasoning 2.It is a comparative discipline in which causes of disease are identified by comparing its frequency in different groups 3.Epidemiological investigations can lead to reductions in the frequency of disease even though biological mechanisms are not known

Two Approaches to Explaining and Controlling Disease Environmental: Mechanistic: Focus on environmental, behavioural, lifestyle causes of disease Focus on biological and pathological mechanisms which cause disease

LUNG CANCER CARCINOGENESIS SMOKING

DiseasePreventive measure Agent Scurvy Smallpox Oral cancer

Sequence of epidemiological reasoning Observation Suspicion Hypothesis

Epidemiological study Statistical association Causal inference Prevention

Types of Epidemiology Classical: Modern: Field epidemiology Descriptive epidemiology Analytic epidemiology Experimental epidemiology Clinical epidemiology Molecular epidemiology

1.Identifying a new syndrome and its cause 2.Assessing risks of exposures to harmful agents 3.Identification of high risk groups 4.Effectiveness of treatment and preventive technologies 5.Needs for and trends in use of health services 6.Variations in diagnosis and treatment planning among practitioners Current Applications of Epidemiology

What is the oral health status of Ontarios elderly? Is there an association between smoking and the onset and course of periodontal disease? Does community water fluoridation increase the risk of hip fracture in the elderly? Does the use of dental services by adolescents decline after school dental programs cease?

How does chronic facial pain affect the quality of life? Is this improved following consultation and treatment at a specialist pain clinic? How much variation is there in dentists diagnoses of caries based on radiographs? What proportion of the population avoid dental treatment because of fear and anxiety, and how is this changing over time?

Does oral infection (periodontal disease) increase the risk of major systemic disorders such as heart disease, stroke and low birth weight?