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Community DentistryYears I - IV
Dr David LockerRoom 521 (ext 4490)
Year I: Term IYear I: Term I
• Epidemiological methods
• Epidemiology of oral diseases
• Determinants of health and disease
Year I: Term IIYear I: Term II
• Current issues in dental health care
• Current issues in dental health care
Year II: Term IYear II: Term I
• Clinical epidemiology and critical appraisal
• Clinical epidemiology and critical appraisal
Year II: Term IIYear II: Term II
• Evidence-based care: small groups learning
• Evidence-based care: small groups learning
Years III and IVYears III and IV• Communication in dental
practice
• Psychological and behavioural issues in dental practice
• Ethics in dentistry
• Jurisprudence
Years I and IIProviding clinical care to patients
Years I and IIProviding 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 EpidemiologyIntroduction to Epidemiology
• Nature and scope of
epidemiology
• Contribution to dentistry
and dental practice
OBJECTIVES:OBJECTIVES:
Two Types of Health CareTwo 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
• Scientific study of the
frequency, distribution and
determinants of health and
disease in human populations
EXPOSURES
INTERVENTIONS
EXPOSURES
INTERVENTIONS
OUTCOMESOUTCOMES
CausationCausation
All decisions that health professionals make health professionals make involve assumptions about causal mechanisms
Aetiology: Risk factors Disease
Therapy: Treatment Improvementin patientscondition
Health service Health services Improved delivery: community
health
Aetiology: Risk factors Disease
Therapy: Treatment Improvementin patientscondition
Health service Health services Improved delivery: community
health
Causal Relationships in Health CareCausal 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
Characteristics of Epidemiology
1. Science
2. Populations and population sub-groups
3. Prevalence, incidence and risk
ScienceScience
A systematic set of methods
for producing knowledge
about events and their
relationships which eliminates
chance, bias and error.
A systematic set of methods
for producing knowledge
about events and their
relationships which eliminates
chance, bias and error.
Power of EpidemiologyPower of Epidemiology
1854 London cholera epidemic
1940 Fluoride and dental caries
1970 US toxic shock syndrome
epidemic
London cholera epidemics1848-1854
Table 1: Results of Snow’s InvestigationTable 1: Results of Snow’s 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. pump 10 not living near pump73 living near Broad St. pump 10 not living near pump
83 Deaths*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
* 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
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
• Focus on biological and pathological
mechanisms which cause disease
LUNG CANCERLUNG CANCER
CARCINOGENESIS
SMOKINGSMOKING
Disease Preventive measure
Agent
Scurvy 1753 1928
Smallpox 1798 1958
Oral cancer 1915 1974
Sequence of epidemiological reasoning
Observation
Suspicion
Hypothesis
Epidemiological study
Statistical association
Causal inference
Prevention
Types of EpidemiologyTypes 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
Current Applications of Epidemiology
What is the oral health status of Ontario’s 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?
Does oral infection (periodontal
disease) increase the risk of
major systemic disorders such as
heart disease, stroke and low
birth weight?