Showing relationship between Epidemiology, Bio-statistics and Dental public health activities for 4th year dental students to get more understanding on why they need to do students' research project and how to apply it!

1. Dr Tin Myo Han
Department of Community Dentistry
Kulliyyah of Dentistry, International Islamic University, Malaysia

2. Epidemiology
Biostatistics
Public Health/ Dental Public Health
25/9/2014

3. 25/9/2014
IIUM

4. Epidemiology of Dental Caries & Periodontal Disease
- Magnitude (prevalence of Dental Caries & PD)
- Analysis of Epidemiological Data:
*Comparison between clinic’s register and community survey
- Applicability of Epidemiological Data analysis
25/9/2014
•Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
•Public Health Activities: -Prevention & Promotion of Oral Health: Action Plan to reduce Periodontal Disease burden
EPIDEMIOLOGY
Bio-stat
•Assignment for Students
DPH

5. 25/9/2014
A public dental Clinic
(KK-Gigi, Kuantan)
In accordance with clinic’s register,
Period : from 1st January 2013 to 31st December 2013
Total dental Patients : 500 patients
-Adult dental caries : 220 cases
-Periodontal diseases : 110 cases
-Pediatric dental caries : 70 cases
-Dentures : 20 cases
- Dental check-up : 30 cases
- Oral surgical cases : 45 cases
- Orthodontics & other : 5 cases

6. 25/9/2014
A Community Oral Health Survey
- Community dentistry department, KOD, IIUM, conducted a community survey in Kuantan to estimate the magnitude of common oral health problems in 2013
-Total 350 dental caries cases
-250 periodontal cases
-25 newly diagnosed oral ulcer cases and
-15 dental injury cases (old + new)
- were identified from 5000 persons under the study

7. Epidemiology of Dental Caries & Periodontal Disease
- Magnitude (prevalence of Dental Caries & PD)
- Analysis of Epidemiological Data:
*Comparison between clinic’s register and community survey
- Applicability of Epidemiological Data analysis
25/9/2014
•Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
•Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal Disease
EPIDEMIOLOGY
Bio-stat
DPH
•Assignment for Students

8. 25/9/2014
Q 1. How to measure magnitude of Dental Caries & PD
(epidemiological measurement)?
( Rate,Ratio, Proportion, Prevalence and Incidence)?
Q 2. Which epidemiological measurement will be used to
compare these epidemiological data between the
public dental clinic and the community survey?
Q3. What is your conclusion on the epidemiological data
analysis ?
Q4. What should you do to get more understanding
on the situation ? Why ?

9. Public Dental Clinic
Community Survey
Proportion of dental caries
(adult + Child) in 2013
= ( 220 +70)/500 *100
= 58% of patients /year
Proportion of PD in 2013
= 110/500 *100
= 22% of patients/year
 Ratio of Dental Caries and Periodontal cases
= 290:110
= 29:11 ~ 3:1
Prevalence of Dental caries ( 2013)
= 70 cases per 1000 population
Prevalence of PD
( 2013)
= 50 cases per 1000 population
25/9/2014

10. Public Dental Clinic
Community Survey
Proportion of dental caries
(adult + Child) = ( 220 +70)/500 *100
= 58% of patients
Proportion of PD
 = 110/500 *100= 22% of patients
Prevalence of Dental caries ( 2013)
= 70 cases per 1000 population
Prevalence of PD
( 2013)
= 50 cases per 1000 population
25/9/2014
Prevalence Dental Caries = 58% or 580 cases per 1000 patients per year
Prevalence of PD = 220 cases per 1000 patients per year
Ratio of Dental Caries & PD
= 290:110 (or) 58 :22
= 29:11 ~ 3:1
Ratio of Dental Caries & PD
= 350:250 (or) 70:50
= 7:5 =1.4 :1~ 1.5 :1
RATIO

11. 25/9/2014
Q 1. How to measure magnitude of Dental Caries & PD
(epidemiological measurement)?
( Proportion, Prevalence and Ratio)?
Q 2. Which epidemiological measurement will be used to
compare these epidemiological data between the
public dental clinic and the community survey ?
Q3. What is your conclusion on the epidemiological data
analysis ?
Q3. What should you do to get more understanding
on the situation ? Why ?

12. 25/9/2014
“We have more dental caries cases than PD! (3:1)” ……” Prevalence of dental caries in the clinic higher than that of PD” ! (Clinic attendance rate)
“In our community survey also more dental caries cases than PD! (1.4:1)” …”Prevalence of dental caries is also higher than that of PD in community”…
..” However, PD cases were found more in the
community survey than clinics “ ……………
(3:1) vs (1.4:1)

13. 25/9/2014
Q 1. How to measure magnitude of Dental Caries & PD
(epidemiological measurement)?
( Proportion, Prevalence and Ratio)?
Q 2. Which epidemiological measurement will be used to
compare these epidemiological data between the
public dental clinic and the community survey ?
Q3. What is your conclusion on the epidemiological data
analysis ?
Q4. What should you do to get more understanding
on the situation ? Why ?

14. 25/9/2014
..” However, PD cases were found more in the
community survey than clinics “ ……………
(3:1) vs (1.4:1)
..” We want to know why PD cases were found more in the community survey than in the clinic “ “ Which factors are influencing on it?
“Epidemiological question (or) starting point for Epidemiological study “

15. 1.Trend study
2.Community diagnosis
3.Health services evaluation
4.To know the individual risks and chances
5.Syndrome identification
6.Completing the clinical picture
7.Searching for causes / risk factors for establishing causal relationship (New diseases or existing diseases)
15

16. 25/9/2014
Why PD cases were found more in the community survey than in the clinic“
“ Which factors are influencing on it?

17. 25/9/2014
TIME
PLACE PERSON
Agent
Host
Environment
Causation Triads
Distribution Triads
MOT

18. 25/9/2014
TIME
PLACE PERSON
Agent
Host
Environment
Causation Triad
Distribution Triad

19. Epidemiology of Dental Caries & Periodontal Disease
- Magnitude (prevalence of Dental Caries & PD)
- Analysis of Epidemiological Data:
*Comparison between clinic’s register and community survey
- Applicability of Epidemiological Data analysis
25/9/2014
•Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
•Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to Combat Periodontal Disease
EPIDEMIOLOGY
Bio-stat
DPH
•Assignment for Students

20. “Role of Biostatistics in Epidemiological Investigation “
25/9/2014

21. 25/9/2014
Community Survey: December 1st -31st,2013
Clinic: Klinik Kasiharan Balok
“Distribution of disease (Distribution Triad)”
Clinic register:1st January to December 31st,2013
Community: Sungi Lembing
Survey: 250 PD cases /5000 person
Clinic: 110 PD cases/500 Patients
TIME
PERSON
PLACE

22. 25/9/2014
Community Survey: December 1st -31st,2013
“Distribution Triad: TIME
Balok Clinic register: 1st January to December 31st,2013
Distribution: endemic pattern
Distribution: epidemic/outbreak pattern

23. 25/9/2014
“Distribution Triad: PLACE
Residence: Out of 110, -108 patients (Balok community) -2 patients (Beserah)
•* * * *
•* * * *
*
KK Balok Dental Clinic
Community Survey: December 1st -31st,2013
Residence:
Out of 250,
-108 cases
(Sungai Lembing )
-142 patients
(Flood Relief Center
Sungai Lembing)
•* * * *
•* * * *
•* * * *
Epidemiological Mapping

24. 25/9/2014
Community Survey: December 1st -31st,2013
“Distribution of disease (Distribution Triad)”
TIME
3rd to 7th December 2013

25. 25/9/2014
“Distribution Triad: PERSON (Age,Gender,Race,Edu & Occupation)
Age Groups
Periodontal Cases
Significant test &
“p” Value
Community Survey Sungai Lembing
(n=250)
n(%)
Public Dental Clinic (Balok) (n=110)
n(%)
< 20 years
10 (4)
6 (6)
X2 test
“p” >0.05
21-40 years
63(25)
28 (25)
41-60 years
127(51)
61 (55)
>60 years
50(20)
15(14)
Total
250
110
Summary descriptive
statistics
Minimum = 18
Maximum = 67
Mean(±SD )= 43(± 5.1)
Minimum =17
Maximum = 65
Mean(±SD )= 44(± 4.9)
“ t” Test
“p” >0.05

26. Based on distribution triad analysis,
- unexpected increase in number of PD cases was found
2 weeks after Flood (time)
- 56.8%(146/250) of them were from Flood relief centers (place)
- 51% ( 127/250) were 41-60 years old ( Person)
- Thus, more PD cases in Community survey may be more occurrence of PD among Persons from flood relief centers
25/9/2014
Hypothesis of Distribution

27. 25/9/2014
AGENT
ENVIRONMENT
HOST

28. 25/9/2014
AGENT
Ref: Basic Epidemiology assignment answered by dental students (2014-2015)

29. 29
?PD Knowledge
Diet/Sweet
?Stress
AGENT
Most likely causes of PD in Community Survey in Kuantan 2013

30. 25/9/2014
Risk factors
Periodontal Cases
Significant test &
“p” Value
Community Survey Sungai Lembing
(n=250)
n(%)
Public Dental Clinic (Balok) (n=110)
n(%)
Yes
No
Yes
No
X2 test
“p”
Poor Oral Hygiene
67%
33%
42%
58%
Stress (+)
70%
30%
30%
70%
DM (+)
47%
53%
27%
73%
-Significant Association between “(Poor oral hygiene & PD)”
(Stress & PD ) were found in community survey

31. 25/9/2014
HOST



32. 25/9/2014
HOST
 More severe PD cases were seen among: - more than 41 years old (60%), - female (67%) and - DM patients ( 76%)

33. 25/9/2014
ENVIRONMENT
Macro environment :
-weather (flood)
-Social status ( flood relief centre)
- OH materials and supply
-Other factors
Micro environment : -Oral flora changes because of Oral hygiene practices , Stress, Underlying Medical disease (DM)

34. Based on causal triad analysis, Causes of more PD cases were :
- Poor OH practices , Stress, and underlying medical disease (DM) (Agent)
- Severe PD were above 41 years old, female, DM (Host)
- flood in Kuantan and changing oral flora (environment)
25/9/2014
Causal Hypothesis

35. 25/9/2014
EPIDEMIOLOGY
Descriptive Hypothesis
Descriptive Statistics
Age , sex, occupation, ( Minimal , Maximum age, Frequency ( %)
Causal Hypothesis
Inferential Statistics
Significant Association b/t age, sex , risk factors & occurrence of disease ( X2, ANOVA)

36. Epidemiology of Dental Caries & Periodontal Disease
- Magnitude (prevalence of Dental Caries & PD)
- Analysis of Epidemiological Data:
*Comparison between clinic’s register and community survey
- Applicability of Epidemiological Data analysis
25/9/2014
•Role of Biostatistics in investigation of more Periodontal Cases Findings in Community
•Public Health Activities (Plan): -Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal Disease
EPIDEMIOLOGY
Bio-stat
DPH
•Assignment for Students

37. Prevention & Promotion of Oral Health: Action Plan to reduce burden of Periodontal
25/9/2014

38. Primary prevention :
-Screening PD among community & risk populations (self-reported questionnaires & professional screening (BPE)
 Secondary prevention :
- Early diagnosis and prompt treatment to reduce loss of teeth ( avoidable )
Tertiary prevention (Rehabilitation) :
Quality of life of PD patients!
25/9/2014

39. 25/9/2014

40. Oral health care in unusual situation ( eg. flood) :
25/9/2014

41. More PD cases in Community survey
Public Dental Clinic vs Community Survey (Case findings of caries and PD) ( 270 vs 350 in dental caries) & (110 vs 250 in PD)
Dental Caries vs Periodontal Disease
( 3:1 in Public Clinics & 1.4 :1 in Community survey
25/9/2014

42. 25/9/2014
In the scenario, Ratio of Dental Caries &
PD, Dental caries ceases are higher than PD in both private dental clinics data and community survey.
Q-1 : Give reasons for attending less PD at public dental clinics and finding less PD in community survey comparing with dental caries?
Dental Caries vs Periodontal Disease?

43. Answers 1:
Nature of diseases (Overt caries vs hidden PD cases)
Knowledge of patients on PD
Awareness of patients on PD & Dental services
 Oral health seeking behavior ( peer )
Other unknown factors (!!! Research)
25/9/2014

44. 25/9/2014
In the scenario, more Dental caries and PD cases were found in community survey than public dental clinic
Q-2 : Give reasons for finding more Dental caries and PD cases in community survey?
Community survey data vs Public dental clinic data?

45. Answers 2:
Active case finding (community survey) vs passive case finding ( public dental clinic)
Iceberg phenomenon
Socio-economic and cultural factors
( communication, financial support, value and norm on oral health)
Knowledge of patients on OH care & services
Other factors (unknown )!! Research
25/9/2014

46. 25/9/2014

47. 25/9/2014
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“ Oral Health Manpower & Trends of common oral health problems in “MALAYSIA ” comparing with Japan, & Singapore ) 4th Year Dental Students ( 2014-2015)