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. “