Community dentistry

1. Introduction to Dental Public
Health
By
Dr. Farooq Ahmad Chaudhary
BDS, MPH, FRSPH (UK), MDPH (Malaysia), PhD (Malaysia)

2. Code Lecture Topic Learning Objectives of Lecture
4.7.1 Introduction:
Concept of dental
Public Health
 Definition of PH & DPH ✔
 Aims & Tools of DPH ✔
 Iceberg phenomenon
 Upstream vs downstream
 Top 10 achievements of PH in 20th
century ✔
4.7.2 Core functions of
Public Health
 Core functions and essential health
services of DPH ✔
 Criteria for a public health problem ✔
 Procedural steps in planning DPH
program ✔
 Impact of oral disease
4.7.3 Role of Public
Health dentist
 Comparison between clinical dentistry
and DPH ✔
 Functions of Public Health Dentistry ✔
BLOCK IV, Module 7, Dental Public Health

3. Public Health
“The science and art of preventing disease,
prolonging life, and promoting physical
health and efficiency through organised
community efforts” (Winslow, 1920)

4. ‘The science and art of preventing disease,
prolonging life and promoting health and
improving the quality of life through the
organised efforts and informed choices of
society, organisations, public and private,
communities and individuals’ (Wanless 2004)

5. Dental Public Health
‘The science and art of preventing oral disease,
promoting oral health and improving the quality
of life through the organised efforts and
informed choices of society, organisations,
public and private, communities and
individuals’
(Gallagher 2005, after Wanless
2004)

6. Phases of Public Health
In the history of Public Health 4 distinct phases.
1. Disease control phase (1880-1920)
2. Health promotional phase (1920-1960)
3. Social engineering phase (1960-1980)
4. Health for All phase (1981-2000)

7. Disease Control Phase (1880- 1920)
Control of man’s physical environment. E.g. water
supply, Sewage disposal etc. These measures were
not aimed at the control of any specific disease.
Sanitary legislation e.g. Sanitary awakening in
England.

8. Health Promotional Phase: (1920-1960)
Beginning of 20th century, a new concept, the
concept of health promotion, began to take shape.
Initiate as personal health services such as,
- Mother and child health services
- School health services
- Industrial health services
- Mental health rehabilitation services

9. Health Promotional Phase: (Cont.)
Two great movements were initiated for human
development during the first half.
1. Provision for basic health services through the medium
of primary health and subcentres for the rural and
urban concept of health center was first quoted in
1920, by Lord Dawson of England
2. Second great movement was community development
programme promote village development through the
participation of whole community.

10. Social engineering phase (1960-1980)
 With advance in preventive medicine and practice of
public health, the pattern of disease began to change in
the developed world.
 Many of the acute illness problems solved, new health
problems in the form of chronic disease began to
emerge, e.g. cancer, diabetes, cardiovascular disease,
and alcoholism etc.
 These Problems could not be tackled traditional
approaches to public health isolation, immunization and
disinfection.
 A new factor Risk Factor as determinants of these
disease came existence. Social and behavioural aspects
of disease and health were given a new priority.

11. Health for All phase (1981-2000)
 Most people in the developed countries enjoy all the
determinants of good health, income, nutrition and
education, sanitation etc.
 In contrast, only 10-20% of the population in developing
countries enjoy access to health services of any kind.
 Against the background in 1981, WHO target to provide
Health for all by the year 2000, that is attainment for all of
a level of health that will permit all people to lead a
socially and economically productive life.

12. Aims (Goals) of PH & DPH
 To assess and monitor the health of communities and populations at risk to
identify health problems and priorities.
 To formulate public policies, to solve local and national health problems and
priorities.
 To assure that all populations have access to cost-effective and appropriate
care, which includes health promotion and disease prevention services.
 Assuring the quality and accessibility of health services.
 Preventing epidemics and the spread of disease & Preventing injuries.
 Promoting and encouraging healthy behaviors.
 Protecting against environmental hazards.
In short, the aims of public health are to save money, improve the quality of life,
help population thrive, and reduce human suffering.

13. Tools (core areas) in DPH
1) Epidemiology
2) Biostatistics
3) Social Sciences
4) Principles of Administrations
5) Preventive Dentistry

14. 1. Epidemiology
The study of distribution and determinants of
health related event in population and the
application of this study to control health problem.
Objective:
- to define magnitude of disease
- to identify etiological factor
- to provide data necessary for planning,
implementation and evaluation of PH programme.

15. 2. Biostatistics
Science of compiling, classifying and tabulating
numerical data and expressing the results in a
graphical form.
Objectives:
- to define normality of data
- to test whether the difference between two population regarding a
particular attribute is real or a chance occurrence.
- to study the correlation or association between two or more attributes
in the same population .
- to evaluate the efficacy of vaccines etc, by control studies
- to evaluate achievements of public health programmes
- to fix priorities in public health programmes.

16. 3. Social Sciences
Usually include:
 Sociology
 Cultural anthropology
 Psychology
To know why effort and effect do not match each
other in PH programme.
Health programmes prepared to aid public health
worker in planning, evaluation, fluoridation, etc, in
interest of dental profession.

17. 4. Principles of administration
Organization:
 Deals with the structure of an agency .
 Way people are arranged into working groups
within it.
Management:
 Handling of personnel and operations in such a
way that the work of agency gets done.
 Leadership quality.

18. 5. Preventing Dentistry
Levels of prevention:
Primary – health promotion
specific protection (immunization,
hygiene)
Secondary– early diagnosis
prompt treatment
Tertiary – disease control

19. Core functions of DPH
 Oral Health promotion and improvement.
 Oral Disease surveillance and prevention.
 Delivering dental treatments.
 Policy and strategy development and implementation.
 Conducting field activities.
 Conducting school health programme.

20. What would happen if we didn’t
have public health approach?
 Oral infectious diseases such as Dental Caries,
Periodontitis and oral cancer would be more
prevalent.
 People would be ill from preventable Oral
diseases.
 More children would be suffering from dental
caries.
 More youth and adults would be smoking or
abusing drugs and alcohol.
 Ultimately economy of nation will go down.

21. Procedural steps in dental public
health.
 Survey
 Analysis
 Programme planning
 Programme operation
 Financing
 Programme appraisal (Evaluation)

22. Survey
 Based on chief complaint of the population.
 Survey are methods for collection of data analysing
and evaluating them in order to determine the
amount of disease problems in a community.
 Parameters include in survey:
- assessment of socioeconomic status of community.
- nature of distribution of community.
- resources available for elimination of problem.
- attitude of community towards health providers.

23. 2. Analysis
 To define characteristics of specific health
problems in the community.
 Electronic data processing media such as
computers are resorted for analysing data.

24. 3. Programme planning
 Designed programme should be accepted by the
community and the people should show an
interest in it.
 It has to be ensured that the community is well
informed about the programme and that they
participate in all steps involved.

25. 4. Programme operation
 A public health team constituting professionals
in various disciples.
 Employed for executing the programme
 E.g: water fluoridation in a community with
higher prevalence of dental caries.

26. 5. Financing
 Through funds provided by the governments/ by
local or state authorities.
 Public health personnel
- identify source for securing funds.
- plan for the management of same funds.

27. 6. Programme appraisal
 Effectiveness of programme is assessed.
 Dimensions:
efficiency
appropriateness
adequacy
possible side effects

28. Criteria of Public health problems
To be consider as PH problem a disease must meet
one or more of the following criteria:
 Disease should be widespread or serious.
 Consequences of disease are severe to community &
individuals.
 Effective prevention methods/treatment should be
available.
 Cost of disease in terms of money, psychological and
physical trauma is great.

29. Similarities of Community Dentist &
Clinician
Public Health Dentist Clinician
Survey Examination
Analysis Diagnosis
Program Planning Treatment Planning
Program Operation Treatment
Financing Payment of Service
Evaluation Appraisal

30. Difference Between Community Dentist
& Clinician
Public Health Dentist Clinician
Deals with groups Deals with one patient
He goes to community Patient comes to clinician
Decision made with consultation Ones own decision
Work is accountable Independent care provider

31. Essential PH & DPH services
 Monitor oral health
 Diagnose and investigate
 Inform, educate, empower
 Mobilize community
partnership
 Develop policies
 Enforce laws
 Link to / provide care
 Assure a competent workforce
 Evaluate
 Research

32. Ten great achievements in Public
health, 1900-1999
1. Vaccination.
2. Motor-vehicle safety.
3. Safer workplaces.
4. Control of infectious diseases.
5. Decline in death from coronary heart disease & stroke.
6. Safer and healthier foods.
7. Healthier mothers and babies.
8. Family planning.
9. Fluoridation of drinking water.
10. Recognition of tobacco use as a health hazard.

33. THANK YOU