● “Science & art of prev oral disease, promoting oral heath & improving QOL thr organised
efforts of society”
● 3 functions: Assessment (assess, investigate, analyse), Policy Development (advocacy,
prioritising needs, planning), Assurance
Contributing Disciplines
● Epidemiology: patterns of disease (who, what, where, when)
● Demography: study of population (size, density, fertility, mortality, growth, age distrib,
migration, vital stats & interaction w social/economic factors)
● Statistics
● Health economics: study of application of economic theory to healthcare (resources =
finite)
● Sociology/psychology: behaviour change/communication b/t clinicians & pts
● Health service management & planning: changing structure, org & finance →
planning, effectiveness, efficiency
● Health promotion: enabling ppl to have increased control over health & its
determinants → improve health
● EBP: decisions based on known facts [@thedentalelf on Twitter, cebd.org]
Health Promotion - Dahlgren & Whitehead
a) Focus on Wider Determinants of Health
● General socioeconomic, cultural & environ conditions
● Living/working conditions (work environ, education, agriculture/food prod,
unemployment, water/sanitation, healthcare services, housing)
● Social & community networks
● Indiv lifestyle factors
● Age, sex, constitutional factors
b) Working w range of agencies/sectors
c) Adopting strategic approach using complementary actions to promote health of
population
Sociology
● Class, material deprivation, education, employment, living circumstances
● In relation to health, health-related behaviour, use of healthcare services, org of
healthcare
Psychology
● Investigate ptl causal links bt psychosocial factors & health at population level
● Mind/body/health, personality, psychology of illness processes (dr-pt interaction, coping
w diseases), theoretical models of health promotion & disease prev
Clinical Practice vs Public Health Practice
, ● CP: exam, Dx, Tp, informed consent for Tx, mixture of care/cure/prev, payment,
evaluation
● PHP: assessment of need, analysis of data, programme planning, ethics & planning
approval, programme implementation, types of finance, appraisal & review
Public Health Approach
● Example on ppt
a) Assessment
● Assess status & health needs of community
● Analyse determinants/contrib factors of disease locally & adequacy of existing health
resources
● Investigate adverse events & health hazards
b) Policy Development
● Prioritise needs from community needs assessment
● Action plan for community w long-range strategic plan reflecting wide participation
● Advocacy - req networks of support/communication w health-related organisations,
media & general public
c) Assurance
● Management plans
● Implementation & evaluation of mandated programmes/services
● Educating public about current health status, healthcare needs, +ve health behaviours,
healthcare policy issues
Measuring Oral Health & Impact of Disease
● Prevalence = disease existing at given point in time (% infected population / population
at risk)
● Incidence = amount of new disease bt 2 points in time (number new cases / population
at risk in given time period)
Why we measure Oral Disease
● Indiv: clinical management (Dx, Tx need & Tx outcome), research (test effectiveness of
Tx/products)
● Population: record prevalence of disease, aid understanding of causes of disease,
indicate population Tx need, evaluation PHP outcomes)
Recording Oral Disease Conditions
● Using index (grading system → consistency)
Ideally..
● Simple: easily understood, easily used (prev invalid measurements), easily administered
(allow large number subjects)
, ● Objective: not subjective, clear-cut categories, good if relates to clinical stages of
disease
● Valid: sensitive & specific, measures what intended to
● Reliable: inner workings of index
● Reproducible: intra-examiner (same examiner, diff times), inter-examiner (diff examiner,
same time)
● Quantifiable: output → statistical analysis
● Sensitive: measure small changes, reversible if disease is
● Acceptable: to subject (time, not embarrassing/painful/demeaning)
Impact of Oral Disease
● Pain/discomfort
● Limited function
● Sleepless nights
● Fear/anxiety
● Social attractiveness (aesthetics, self-esteem)
● Cost of tx (to pt, NHS, society)
● Time (off work/school) → decreased workforce productivity, poor educational
performance
Measuring Impact
a) Dental Indices
● DMFT → caries
● RCI → root caries
● CPITN (BPE) → PDD
● PI/BI
● Modified Gingival Index → gingivits
● IOTN
● PAR → ortho Tx outcome
● Deans Index → fluorosis
● Modified DDE → developmental defects of enamel
● Limitations: all normatively derived - from clinical POV, don’t account for impact of oral
health on indivsv wider functioning
b) Sociodental Indicators
● Measure oral health-related QOL
● Record extent that oral disease compromises aspects of daily life that pts value
● Record interventions that mitigate effects → restore QOL
● E.g. OHIP-14: responses on 5 point scale
What is Health?
● Complete state of physical, mental & social wellbeing
Conceptual Model
