Dental Public Health

Dental Public Health

Dental Public Health

Introduction

Topics

Historical DevelopmentDental Care Delivery

in the United Statesaround the world

Financing Dental CareLegislative InitiativesEducation and PromotionTarget PopulationsLesson PlanProgram PlanningProgram Evaluation

Oral EpidemiologyResearch MethodsBiostatisticsEvaluation of Literature and ProductsCareers in the GovernmentEntreprenurial InitiativesBoard Review

The Prevention Movement

Dental Hygiene’s Relation to Dental Public Health

Historical Development

Dental Hygiene as Forerunner to the Prevention Movement

Dr. Alfred FonesFounder of Dental

Hygiene School and First Author of Dental Hygiene College Textbook

Historical Development Continued

• Practice Settings– Schools– Industry– Military– Hospitals

• Professional Organizations

Preventive Modalities

Dental Hygiene Treatment Fluoridation Xylitol Dental Sealants Oral Cancer Exams and Tobacco

Cessation Nutritional Counseling Atraumatic Restorative Treatment (ART) Mass Education/Media

Dental Care Delivery

In the United States

Dental Care Delivery

F E D E R A LD ep artm en ts o f th e

F ed era l G overn m en t

N O N G O V E R N M E N TP riva te P rac tice

In s titu tion s , S ch oo lsIn su ran ce-B ased M od e ls

S TA TED ep artm en ts o f S ta te

S ta te P rison sC om m u n ity C lin ics , S ch oo ls

V eh ic les o f D en ta l C arein th e U n ited S ta tes

Dental Public Health

The oral health care and education, with an emphasis on the utilization of dental hygiene sciences, delivered to a target population

Factors Affecting Dental Health

Access to CareRestriction of dental

hygiene servicesShortage of Medicaid

providersFinancial Situations

InsuranceMedicaid

Transportation

Factors Affecting Dental Health, Continued

SES Relation to Dental Health

Dental Hygiene Sciences

Increase in the Geriatric Populations

Malpractice Insurance

Changes

Federal InfluenceExecutive Branch System

Legislation Senate and House ofRepresentatives

Executive President andCabinet

Judicial Federal Court

Department of Health and Human Services• Public Health

Service Operating Division

• Human Services Operating Division

Public Health Service Operating Division

National Institutes of Health Food and Drug Administration Centers for Disease Control and

Prevention Agency for Toxic Substances and

Disease Registry

Indian Health Services Health Resources and Services Administration Agency for Health Care Policy and Research Substance Abuse and Mental Health Services

Administration

Human Services Operating Division

Centers for Medicaid and Medicare – Medicaid– Medicare

Administration for Children and Families Administration on Aging

Public Health Service

PHS works toward improving and advancing the health of our nation.U.S. Surgeon GeneralDental Hygienists work as Public Health Officers.

Other Federal Departments

Influencing Dental Care

Agriculture Defense Education Justice

Labor State Treasury Veteran’s Affairs United States Peace Corps (which

is an executive branch agency)

Individual State Influence

State Dental Divisions

Medicaid S-CHIPS Prisons Tribal Clinics Institutions Community

Clinics

Dental Health Care Personnel

Need Demand Utilization Supply Dental Hygiene

Shortages Dental Hygienist

to Dentist Employment Ratio = 1:2

Dental Finance

Public and Private Funding of Dental Care

Historical Funding of Dental Care

Patient’s Responsibility The Advent of Dental

Insurance Medicaid Coverage for

Dental Services Today’s Dental

Financing

Payment Methods

Fee-for-Service Capitation Plans Encounter Fee Plans Barter System

Fee-for-Service

A dental practice sets a fee, and a patient and/or third party pays for the fee.UCR: usual, customary and reasonable feeIndemnity plans pay fee-for-service.Discounted coverage available and sliding scales for certain patients in certain clinics

Capitation Method

Dental Managed Care A certain amount is paid to a dental

practice for a certain number of patients. Payment is received whether treatment is provided or not.

Many times employees will state that they are not paid for “cleanings” provided; however, this is not an accurate statement.

Encounter and Barter

Encounters are for an arrangement paid for each visit.

Barter system is used when the dental provider negotiates payment by exchanging goods and services.

Insurance Plans

Dental Service Corporations Health Service Corporations Preferred Providers Organizations Individual Practice Associations Capitation Programs

Dental Billing

Claim Form ADA CDT Payment Plans Dental Credit Cards Explanation of

Benefits

Government Role

• Research• Disease Prevention• Disease Control• Program Planning and Operation• Funding for the Education of

Dental Professionals• Regulation

Government’s Role• U.S. PHS• Federal Block

Grants• State

Governments• Local

Governments

Medicaid Title XIX State/Federal

Program Your State’s

Medicaid Program Other State’s

Medicaid Program

Dental Care Delivery

Around the World

International Dental Health Care• Dental Diseases• Historical Perspective• Demographics and the Dental

Hygienist• Global Education of the Dental

Hygienist• The Role of the Dental Hygienist• Access to Care in Other Countries

International Dental Health Care, Continued• Dental Public Health

Programs and Campaigns

• Oral Health Policies• Lobbying Groups• International Dental

Organizations

International Overview

Related Dental Professionals Regulation of Dental Hygienists Independent Practice

Portability of Licensure Future of Dental Hygiene

Legislative Initiatives Affecting Dental Hygiene

Practice

In the United States

Issues in the United States

Preceptorship/Alternative EducationOn-the-Job Training for Supragingival

ScalingRestrictive Supervision Laws Affecting

Access to CareAdvanced Dental Hygiene Practitioner

State Governments

Legislative Executive Judicial

Major Bodies of Law

Common Law Statutory Law Constitutional

Law Administrative

Law

Laws Pertaining to Dental Hygiene

• State Dental Hygiene Practice Act, sometimes referred to as the statute

• Supervision Status

State Dental Board

• Administrative Law• Governs Dental Hygienists and the

Practice of Dental Hygiene• Rules and Regulations• Self-Regulation

Supervision Types

Unsupervised

Independent Practice

Collaborative Practice

General Supervision

Indirect Supervision

Direct Supervision

International Overview

Related Dental Professionals Regulation of Dental Hygienists Independent Practice

Portability of Licensure Future of Dental Hygiene

Dental HealthDental Health

Education and Promotion

Health Education Principles

Five Dimensional Health Model– Physical– Mental– Social– Spiritual– Emotional

Dental Health Education

Goal: to prevent dental diseases utilizing appropriate dental health interventions

Health Education Principles

Health Education: the education of health behaviors that bring an individual to a state of health awareness

Health Promotion: the informing and motivating of people to adopt health behaviors

Health Behavior: an action that helps prevent illness and promotes health for a population

Goals of Dental Health Education

Provide Effective Dental Health Education.

Change Values Aimed at Improving Health.

Healthy Behaviors

Stages of Learning

• Unawareness • Awareness • Self-Interest • Involvement • Action • Habit

Transtheoretical Model

Precontemplation Contemplation Preparation Maintenance Action

Theory of Reasoned Action

Attitude toward the behavior Subjective norms Perceived behavioral control Intention Behavior

Social Cognitive Theory

• Self-Efficacy Theory• Knowledge –

Behavior – Environment

Empowerment Models

• Participant Oriented• Social Environments

Motivation

• Motivation is the will of the individual to act.

Maslow’s Heirarchy of Needs

Self-Actualization Need for Self-Esteem Belongingness and

Love Safety Needs Physiological Needs

Behavioral Conditioning Classical

Conditioning Operant

Conditioning Modeling

Lesson Plan

Development

Assessment Phase

Assess target populations’needs interestsabilities

Assess resources

Dental Hygiene Diagnosis

Formulate Findings from Assessment into a Diagnosis.

Prioritize Goals.

Planning

Broad Goal Formulation

Specific Objectives

Select Teaching Methods.

Implementation

Be Prepared. Effective Teacher

Characteristics

Evaluation

• Qualitative Measurement• Quantitative Measurement• Information Provided to Appropriate

Parties

Target Populations

For the Practicing Hygienist

Target Populations

A group of individuals with similarities of some sort whether it be

age, race, educational background, life situations, and/or health

conditions

Specific Target Populations

Family Caregivers Health Care

Workers Hospice Workers Persons with

Medical Conditions/Diseases

Developmentally Disabled

Hearing Impaired

Visual Impairments

School Teachers

Social Workers

AgesPrenatal InfancyChildrenAdultsOlder Adults

Cultural Diversity

The social, ethnic, and cultural elements that compose a person.

Barriers to Dental Hygiene and Dental CareAge Language Habit

Culture No Finances Lack of Faith

Education Misunderstanding Fear

Transportation Values Safety

Illiteracy Attitudes Denial of Disease

No providers Invulnerability Convenience

Social Issues Education Levels Provider Conflicts

Program PlanningProgram Planning

For the Dental Hygienist

What is a dental public health program?

Educational, clinical, and referral services to a target population

Preventive Programs• School Fluoride Mouthrinse Programs• School Dental Sealant Programs• Xylitol Programs• Mouthguard Programs• Dental Health Educational Programs• Tobacco Cessation Programs• Denture Identification Programs

Dental Public Health Programs

► Healthy Smile Program

► Inner City Health Center Dental Program

► Soroptomist Dental Project

► Matthew 25► Operation Smile

Dental Hygiene Program Planning Paradigm

Assessment Population’s dental needs Demographics Facility Personnel Existing Resources Funding

Dental Hygiene Program Planning Paradigm, ContinuedDental Hygiene Diagnosis Prioritization of needs Formulation of diagnosis to provide goals and

objectives for blueprint

Planning Methods to measure goals Blueprint Address constraints and alternatives.

Dental Hygiene Program Planning Paradigm, ContinuedImplementation Program will begin operation. Revision and changes identified and

employed

Evaluation Measuring goals Qualitative and quantitative evaluation Ongoing revisions employed

Program Evaluation

Dental Public Health

Program Evaluation

Program Planning → Objectives Measurement of Objectives Formative Summative

Evaluation Techniques

Traditional Nonclinical Measurements Interviews Surveys

Clinical Methods Basic BSS Dental Indexes

Government’s Evaluation

• Healthy People 2010 Objectives and Evaluation Mechanisms

• NOHSS• Call to Action

Oral Epidemiology

• Study of Oral Diseases• Multifactorial Nature of Disease• Terminology

• Epidemic Prevalence• Endemic Incidence• Pandemic Etiology• Disease Rates Surveilance• Mortality Risk Factors• Morbidity Index

Oral Epidemiology Reports

Morbidity and Mortality (MMWR)

Healthy People Reports

Surgeon General’s Report

Call to Action

Global Oral Data Bank

Epidemiology of Oral Diseases

Periodontal Diseases

Tooth Loss

Dental Caries

Oral Cancer

Cleft Lip/Palate

Injury

Toothaches

Research

In Dental Hygiene

Significance of Research to Dental Hygiene

Dental public health is based upon programs that have

demonstrated effectiveness in achieving health for the

population.

Types of Research

Historical Descriptive

Survey Observational Case Studies Correlational

Epidemiological Longitudinal Cross-sectional

Retroactive Experimental

(Prospective) Quasi-experimental

Beginning Research

Research Question Does Brand X toothpaste whiten

teeth? Positive Hypothesis

Brand X toothpaste does significantly whiten teeth.

Null Hypothesis There is no statistically significant

difference between Brand X and a placebo when comparing the whitening of teeth.

Research Design

Formulating a hypothesis Review of the literature Methods and materials Statistical evaluation

Experimental Approaches

• Two group pretest/post-test designs• Time series• Post-test only • Solomon three and four group• Factorial • Placebos• Control groups

Sampling Techniques

Randomization

Systematic

Convenience

Stratifying

Informed Consent

Informed Consent is part of examining the ethics of the research project as a whole.

Dental Research

Biostatistics

Categorizing Data• Discrete or Continuous

– Nominal– Ordinal– Interval– Ratio

Descriptive Statistics

Measures of Central Tendency Mean Median Mode

Measures of Dispersion Range Variance Standard Deviation

The Normal Distribution

Gaussian Distribution Bell-Shaped Curve Skewed Data

Graphing Data

Frequency Distribution Table

Grouped Frequency Table

Bar Graph Histogram Polygon 0

10

20

30

40

50

60

70

80

90

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

East

West

North

Correlation Correlation

Coefficients Positive Correlation Negative

Correlation Strong Correlation

Correlation

Pearson Product Movement Correlation Coefficient

Spearman Rank-Order Correlation Coefficient

Statistical Decision Making

►Probability►Type I Error►Type II Error►Degrees of Freedom

Inferential Statistics

Parametric Inferential Statistics Student t-test Analysis of Variance

Nonparametric Inferential Statistics Chi Square Test Other Nonparametric Tests

Interpretation of Data

Statistical Significance

Clinical Significance

Research Results

Validity: Results of the study can be inferred to the general population.

Reliability: The study was conducted in a controlled manner and if repeated would lend the same results; thus, the study is reproducible.

Evaluation of

Scientific Literature and Dental Products

Regulation of Dental Care Products

Food and Drug Administration

American Dental Association Seal of Acceptance

Dental Hygienist’s Role

Critical consumerPatient educationAwareness of

advertising techniques

Evaluation of Scientific Literature Introduction Purpose Research Design Sample Selection

Product Usage Examiners Statistical

Significance Results

Careers in

Dental Public Health

Positions for the RDH

U.S. PHS VA Hospitals Federal Prisons Military Base

Clinics Other Agencies

United States RDH Positions

Commissioned Officer Positions

Civil Service Positions

National Health Service Corps

Other Options

Independent Contractor Employee of Dental Staffing Agency Student Opportunities

COSTEP

Strategies for Creating Dental Hygiene Positions

In Dental Public Health Settings

Populations

HomeboundInstitutionalizedPopulations with DisabilitiesRural Area ResidentsPopulation with Dental PhobiasPopulations faced with Language or Cultural BarriersPatients without Financing

Proposed Plan for Action

Dental Hygiene Program Planning Paradigm Assessment Dental Hygiene Diagnosis Planning Implementation Evaluation

Practice Management Issues

Patient tracking Appointment scheduling Practice promotion Collection of fees

Proposal Development and Presentation

Introduction Significance of

Position Blueprint of the

Operational Program

Conclusion Contracts Teaching

Strategies

Dental Public Health

Review

Community Health/Research Principles

Promoting health and preventing disease within groups

Participating in community programs

Analyzing scientific information, utilizing statistical concepts, and applying research results

Dental Public Health: Contemporary Practice

for the Dental Hygienist:

“The Dental Hygienist is the Premier Dental Public Health

Provider. “