Community Dentistry Years I - IV

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Community Dentistry Years I - IV

  1. 1. Community Dentistry Years I - IV Dr David Locker Room 521 (ext 4490)
  2. 2. Year I: Term I <ul><li>Epidemiological methods </li></ul><ul><li>Epidemiology of oral diseases </li></ul><ul><li>Determinants of health and disease </li></ul>
  3. 3. Year I: Term II <ul><li>Current issues in dental health care </li></ul>
  4. 4. Year II: Term I <ul><li>Clinical epidemiology and critical appraisal </li></ul>
  5. 5. Year II: Term II <ul><li>Evidence-based care: small groups learning </li></ul>
  6. 6. Years III and IV <ul><li>Communication in dental practice </li></ul><ul><li>Psychological and behavioural issues in dental practice </li></ul><ul><li>Ethics in dentistry </li></ul><ul><li>Jurisprudence </li></ul>
  7. 7. ? Years I and II Providing clinical care to patients <ul><li>What is the evidence re: benefit? </li></ul><ul><li>Is the evidence high quality? </li></ul><ul><li>Is the evidence relevant? </li></ul>
  8. 8. Year 1: Fall Term Lecture 1
  9. 9. Introduction to Epidemiology <ul><li>Nature and scope of epidemiology </li></ul><ul><li>Contribution to dentistry and dental practice </li></ul>OBJECTIVES:
  10. 10. Two Types of Health Care <ul><li>Treats individuals </li></ul><ul><li>With physical and psychological disorders </li></ul><ul><li>Aims to RESTORE HEALTH </li></ul>Clinical Practice: <ul><li>“ Treats” communities and populations </li></ul><ul><li>Currently healthy </li></ul><ul><li>Aims to PREVENT DISEASE and MAINTAIN HEALTH </li></ul>Population (Public) Health Practice:
  11. 11. <ul><li>Scientific study of the frequency, distribution and determinants of health and disease in human populations </li></ul>
  12. 12. EXPOSURES INTERVENTIONS OUTCOMES Causation
  13. 13. All decisions that health professionals make health professionals make involve assumptions about causal mechanisms
  14. 14. Causal Relationships in Health Care Aetiology: Risk factors Disease Therapy: Treatment Improvement in patients condition Health service Health services Improved delivery: community health
  15. 15. <ul><li>Comprehensive understanding of oral health and disease </li></ul><ul><li>Understanding of scientific methods </li></ul><ul><ul><li>Causes of oral disease </li></ul></ul><ul><ul><li>Evaluation of interventions </li></ul></ul><ul><li>Role in decisions re: diagnosis and treatment for the individual patient </li></ul>
  16. 16. SCIENTIFIC METHODS CRITICAL APPRAISAL EVIDENCE BASED CARE
  17. 17. Characteristics of Epidemiology <ul><li>Science </li></ul><ul><li>Populations and population sub-groups </li></ul><ul><li>Prevalence, incidence and risk </li></ul>
  18. 18. Science A systematic set of methods for producing knowledge about events and their relationships which eliminates chance, bias and error.
  19. 19. Power of Epidemiology 1854 London cholera epidemic 1940 Fluoride and dental caries 1970 US toxic shock syndrome epidemic
  20. 20. London cholera epidemics 1848-1854
  21. 21. Table 1: Results of Snow’s Investigation 61 Known to have drunk pump water 6 Believed not to have drunk pump water 6 No info 5 In families sending to Broad St. pump for water 3 Children attending school near pump 2 No info 73 living near Broad St. pump 10 not living near pump 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
  22. 22. Fluoride and dental caries (see attachment)
  23. 23. Mechanisms by which fluoride considered to inhibit dental decay <ul><li>1. Pre-eruptive </li></ul><ul><ul><li>- reduce enamel solubility </li></ul></ul>
  24. 24. Mechanisms by which fluoride considered to inhibit dental decay <ul><li>2. Post-eruptive </li></ul><ul><ul><li>- promote remineralization </li></ul></ul><ul><ul><li>- inhibit bacterial acids </li></ul></ul>
  25. 25. Fluoride mechanisms Better understanding of mechanisms Debate re: modes of delivery
  26. 26. Toxic shock syndrome
  27. 27. <ul><li>Epidemiology is a logical discipline which proceeds by way of sequence of reasoning </li></ul><ul><li>It is a comparative discipline in which causes of disease are identified by comparing its frequency in different groups </li></ul><ul><li>Epidemiological investigations can lead to reductions in the frequency of disease even though biological mechanisms are not known </li></ul>
  28. 28. Two Approaches to Explaining and Controlling Disease Environmental: Mechanistic: <ul><li>Focus on environmental, behavioural, lifestyle causes of disease </li></ul><ul><li>Focus on biological and pathological mechanisms which cause disease </li></ul>
  29. 29. LUNG CANCER CARCINOGENESIS SMOKING
  30. 30. 1974 1915 Oral cancer 1958 1798 Smallpox 1928 1753 Scurvy Agent Preventive measure Disease
  31. 31. Sequence of epidemiological reasoning Observation Suspicion Hypothesis
  32. 32. Epidemiological study Statistical association Causal inference Prevention
  33. 33. Types of Epidemiology Classical: Modern: <ul><li>Field epidemiology </li></ul><ul><li>Descriptive epidemiology </li></ul><ul><li>Analytic epidemiology </li></ul><ul><li>Experimental epidemiology </li></ul><ul><li>Clinical epidemiology </li></ul><ul><li>Molecular epidemiology </li></ul>
  34. 34. <ul><li>Identifying a new syndrome and its cause </li></ul><ul><li>Assessing risks of exposures to harmful agents </li></ul><ul><li>Identification of high risk groups </li></ul><ul><li>Effectiveness of treatment and preventive technologies </li></ul><ul><li>Needs for and trends in use of health services </li></ul><ul><li>Variations in diagnosis and treatment planning among practitioners </li></ul>Current Applications of Epidemiology
  35. 35. 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?
  36. 36. 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?
  37. 37. ? Does oral infection (periodontal disease) increase the risk of major systemic disorders such as heart disease, stroke and low birth weight?

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