1. PUBLIC HEALTH DENTISTRY

2. INTRODUCTION The Dental Public Health field has been expanding in scope and complexity with more emphasis being placed on the total dental care delivery system and its impact on oral health status. The Dental Public Health field has been expanding in scope and complexity with more emphasis being placed on the total dental care delivery system and its impact on oral health status.

3. HISTORY  1840 - Term ‘Public Health’  1848 - Public Health act in England

4. DEFINITIONS  Health [WHO] : A state of complete physical, mental and social well being and not merely the absence of disease or infirmity.

5.  Public Health [Winslow] : The art and science of preventing disease, prolonging life and promoting physical and mental efficiency through organized community efforts.

6.  Dental Public Health [The American Board of Dental Public Health] : The science and art of preventing and controlling dental disease and promoting dental health through organized community efforts.

7. ICEBERG PHENOMENON OF DISEASE  Disease in a community may be compared with an iceberg.  Tip of iceberg  what the physician sees in the community [clinical cases]  The vast submerged  Hidden mass of disease portion of iceberg - latent - latent - Inapparent - Inapparent - Presymptomatic - Presymptomatic - undiagnosed - undiagnosed - carriers - carriers  The water line  demarcation between apparent and inapparent disease. inapparent disease.  In hypertension, diabetes, etc, unknown morbidity far exceeds known morbidity.

8. CONCEPTS OF HEALTH 1. Biomedical concepts 2. Ecological concepts 3. Psychosocial concept 4. Holistic concept

9. 1. Biomedical concept  absence of disease  absence of disease  inadequate to solve major health problems (malnutrition, chronic diseases, accidents)  inadequate to solve major health problems (malnutrition, chronic diseases, accidents)

10. 2. Ecological concepts  dynamic equilibrium between man and his environment.  dynamic equilibrium between man and his environment.  disease : maladjustment of the human organism to environment.  disease : maladjustment of the human organism to environment.

11. 3. Psychosocial concept  health is influenced by social, psychological, cultural, economic and political factors.  health is influenced by social, psychological, cultural, economic and political factors.

12. 4. Holistic concept  all sectors of society have an effect on health.  all sectors of society have an effect on health.  health implies a sound mind, in a sound body, in a sound family, in a sound environment.  health implies a sound mind, in a sound body, in a sound family, in a sound environment.

13. CHANGING CONCEPTS IN PUBLIC HEALTH  Disease control phase  aimed at the control of man’s physical environment  aimed at the control of man’s physical environment  eg: Water supply,sewage disposal, etc  eg: Water supply,sewage disposal, etc  Health promotion phase  mother and child health services  mother and child health services  school health services  school health services  industrial health services  industrial health services  mental health & rehabilitation services  mental health & rehabilitation services

14. 2 movements were initiated 2 movements were initiated 1. Basic health services – primary health centres, subcentres 2. Community development programme

15.  Social Engineering phase [1960 – 1980]  Social and behavioral aspects of disease and health given priority  Social and behavioral aspects of disease and health given priority  ”risk factors” as determinants of diseases came into existence  ”risk factors” as determinants of diseases came into existence  Health for all phase [1981 – 2000]  Members of WHO pledged “Health for all by the year 2000”  Members of WHO pledged “Health for all by the year 2000”  The organized application of local, state, national and international resources permit all people to lead a socially and economically productive life  The organized application of local, state, national and international resources permit all people to lead a socially and economically productive life

16. CHARACTERISTICS OF AN IDEAL PUBLIC HEALTH MEASURE 1. Of proven efficacy in the reducton of the targeted disease. 2. Medically and dentally safe. 3. Easily and efficiently implemented, utilizing a relatively small amount of materials, supplies and equipment.

17. 4. Readily administered by non dental personnel. 5. Readily available and accessible to large numbers of individuals. 6. inexpensive, therefore affordable by the majority.

18. 7. Uncomplicated and easily learned by the utilizers. 8. Administered with maximum acceptance on the part of the patient.

19. TOOLS OF DENTAL PUBLIC HEALTH 1. Epidemiology - the branch of medical science dealing with epidemics. - the branch of medical science dealing with epidemics. - the study of the distribution and determinants of health related events in population. - the study of the distribution and determinants of health related events in population.

20. Aims  Minimize / eradicate the disease of health problem and its consequences.  Minimize the chances of its occurrence in future

21. Objective  to define the magnitude and occurrence of disease conditions in man.  to identify the etiologic factors responsible for above conditions.  to provide data necessary for planning, implementation and evaluation of programmes for - preventing - preventing - controlling - controlling - treating diseases - treating diseases

22. 2. Biostatistics - statistics is the science of competing, classifying and tabulating numerical data and expressing the results in a mathematical / graphical form - statistics is the science of competing, classifying and tabulating numerical data and expressing the results in a mathematical / graphical form - biostatistics is that branch of statistics concerned with mathematical facts and data relating to biological events. - biostatistics is that branch of statistics concerned with mathematical facts and data relating to biological events.

23. uses uses  to define normally  to test whether the difference between two populations, regarding a particular attribute is real or a chance occurrence  to study the correlation or association between two or more attributes in the same population  to evaluate the efficacy of vaccines, sera, etc, by control studies  to evaluate achievements of public health programmes  to fix priorities in piblic health programmes

24. 3. Social Sciences - usually include  sociology - usually include  sociology  cultural anthropology  cultural anthropology  psychology  psychology - social scientist become necessary when effort and effect do not match each other and we want to know why - social scientist become necessary when effort and effect do not match each other and we want to know why - new health programmes prepared to aid public health worker in planning, evaluation, fluoridation,etc, in interest of dental profession - new health programmes prepared to aid public health worker in planning, evaluation, fluoridation,etc, in interest of dental profession

25. 4. Principles of administration organization : organization :  deals with the structure of an agency  deals with the structure of an agency  way people are arranged into working groups within it  way people are arranged into working groups within it management : management :  handling of personnel and operations in such a way that the work of agency gets done  handling of personnel and operations in such a way that the work of agency gets done

26. 5. Preventing Dentistry levels of prevention : levels of prevention : primary  health promotion primary  health promotion specific protection specific protection [immunization, hygiene] [immunization, hygiene] secondary  early diagnosis secondary  early diagnosis prompt treatment prompt treatment tertiary  disease control tertiary  disease control

27. Procedural steps in dental public health 1. Survey 2. Analysis 3. Programme planning 4. Programme operation 5. Financing 6. Programme appraisal

28. 1. Survey - based on chief complaint of the population - based on chief complaint of the population - surveys are methods for collection of data, analysing and evaluating them in order to determine the amount of disease problems in a community - surveys are methods for collection of data, analysing and evaluating them in order to determine the amount of disease problems in a community - parameters included in survey : - parameters included in survey :  assessment of socioecoomic status of community  assessment of socioecoomic status of community  nature of distribution of community  nature of distribution of community  resources available for elimination of problem  resources available for elimination of problem  attitudes of community towards health providers  attitudes of community towards health providers

29. 2. Analysis - to define characteristics of specific health problems in the community - to define characteristics of specific health problems in the community - electronic data processing medias such as computers are resorted for analysing data - electronic data processing medias such as computers are resorted for analysing data

30. 3. Programme planning - designed programme should be accepted by the community and the people shold show an interest in it. - designed programme should be accepted by the community and the people shold show an interest in it. - it has to be ensured that the community is well informed about the programme and that they participate in all steps involved - it has to be ensured that the community is well informed about the programme and that they participate in all steps involved

31. 4. Programme operation - a public health team constituting professionals in various disciples - a public health team constituting professionals in various disciples - employed for excecuting the programme - employed for excecuting the programme - eg : water fluoridation in a community with higher prevalence of dental caries - eg : water fluoridation in a community with higher prevalence of dental caries

32. 5. Financing - through funds provided by the governments / by local or state authorities - through funds provided by the governments / by local or state authorities - public health personnel - public health personnel  identify source for securing funds  identify source for securing funds  plan for the management of same  plan for the management of same

33. 6. Programme appraisal - effectiveness of programme is assessed - effectiveness of programme is assessed - dimensions : efficiency - dimensions : efficiency appropriateness appropriateness adequacy adequacy possible side effects possible side effects

34. SIMILARITIES BETWEEN PERSONAL AND COMMUNITY HEALTH CARE PATIENT PATIENT 1. Examination 2. Diagnosis 3. Treatment planning 4. Treatment 5. Payment for service 6. Evaluation COMMUNITY COMMUNITY 1. Survey 2. Analysis 3. Programme planning 4. Programme operation 5. Finance 6. Approval

35. DIFFERENCES BETWEEN PRIVATE DENTAL PRACTICE AND PUBLIC HEALTH DENTISTRY Characteristic Private Dental Practice Public Health Dentistry Target Individual patient community or group of individuals Collection of information History taking and oral clinical examination Analysis of available health and morbidity records

36. Differences… Special investigations Radiography, blood test, biopsies, exfoliative cytology Epidemiological surveys ConclusionsDiagnosis Situational analysis of oral health status and needs and utilization of services

37. Differences… Remedial Measures Treatment plan based on diagnosis, patients attitudes and affordability Action plan based on demands, available resources and priorities Major emphasis Curative and restorative care Promotive and preventive care

38. Differences… Requirements for success Patient’s consent and co-operation Community Participation Service provider Dentist alone, sometimes with an assistant Health team professionals and para professionals, community volunteers

39. Differences… Intervention Appropriate dental procedure Promotive and preventive measure at individual and community level Supportive Disciplines Psychology Sociology, Social psychology, Education, Epidemiology and Biostatistics

40. Differences… Organization & Management Not relevant Very relevant PerspectiveImmediate Long term Evaluation & Results Relief of symptoms and restoration of function Formal programme evaluation

41. Differences… Aftercare Recall, Further sittings Continuing care, Self care Funding Generally by the patient Generally by Government or Local authorities

42. SERVICES PROVIDED THROUGH PUBLIC HEALTH DENTISTRY  Health education  Dental Health camps  Dental treatments  Extraction  Oral prophylaxis  Oral prophylaxis  Flouride applications  Flouride applications  Oral hygiene measure  Oral hygiene measure  School Health Programme  Application of Caries Preventive measures  Demonstration of dental preventive methods and procedures to the community  Dental Public Health activities and field experiences for dental students

43. CONCLUSION Kindness, concern and love for the art of healing earned Hippocrates the immortal title of ‘The Father of Medicine’. Kindness, concern and love for the art of healing earned Hippocrates the immortal title of ‘The Father of Medicine’. The dental profession has primary responsibilitiy for the oral health care of the public. The dental profession has primary responsibilitiy for the oral health care of the public.