Pathways in dental public health

Dental public health is one of the nine specialties of dentistry recognized by the American Dental Association Commission on Dental Accreditation. Dental public health has been defined as the "science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than as an individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis." This article will describe the many career and educational pathways dentists may follow to become irvolved in the practice of dental public health.     

The role of the dental team in promoting dental health and general health through oral health.

The two major dental diseases are related to diet and dirt. These are common risk factors for a number of chronic diseases. A logical approach to the prevention of chronic diseases is to focus on risk factors rather than on specific diseases, a common risk factor approach using health promotion. Health promotion is the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health. The concepts incorporated in health promotion include a promotion of health through public policy, creating supportive environments, developing personal skills, strengthening community action and reorienting health services. The dental team should incorporate the following principles: integration with general health education, encouraging participation of the community, the public and staff in the planning process; making healthy choices the easier choices. By adopting a Common Risk Factor Strategy incorporated into Primary Health Care, dental teams can promote dental health and general health. The latter objective will be achieved by reducing pain and suffering related to dental diseases. A much broader remit for dental teams is outlined, one which will do justice to the abilities and training of all members of the team.     

Racial differences in perception of oral health and oral health behaviours in Singapore.

Knowledge of prevention can influence preventive dental behaviours. This study surveyed knowledge and preventive dental behaviours on the prevention of dental caries and gum disease among the adult population of the three major racial groups in Singapore. Respondents were asked to rate the importance of several preventive measures against dental caries and gum disease. Questions were also fielded on dental behaviours such as preventive visits to the dentist, toothbrushing and flossing. Results showed that there was a general lack of appreciation for the use of flossing, dental sealants and fluoride supplements. Although a majority of respondents thought that regular dental checkups would be essential for prevention, the proportion who actually saw the dentist for preventive care was significantly lower. Respondents provided inappropriate reasons for brushing their teeth. Differences in both preventive knowledge and preventive dental behaviours among racial groups were evident although these were attributed to differences in education and exposure to product information rather than to racial or cultural factors.     

Self-assessed dental health, oral health practices, and general health behaviors in Chinese urban adolescents

The objectives of this study were: to describe perceived dental health status and oral health-related knowledge, attitudes, and behavior in Chinese urban adolescents; to assess the associations of oral health variables with socio-economic status and school performance; and to analyse the relative effect of socio-behavioral risk factors on perceived dental health, perceived need for dental care, and experience of dental symptoms. A cross-sectional survey of 2662 adolescents was conducted in eight capital cities in China; the response rate was 92%. The study population was chosen by multistage cluster sampling and covered three age groups: 11, 13, and 15 years. Data on dental and general health were collected by self-administered questionnaires. Self-assessment of dental health of Chinese adolescents was generally good, only 12% of the students answered that their teeth were "poor" or "very poor", and 9% claimed having "poor" or "very poor" gums. Eleven percent of participants said that other students made fun of their teeth; 24% of the respondents were dissatisfied with the appearance of their teeth, and 41% claimed that they had experienced toothache or symptoms during the previous 12 months. Positive attitudes towards dental care were found in all age groups; 67% of adolescents brushed their teeth at least twice a day and 48% of the students used fluoridated toothpaste. Only 26% of the students visited a dentist during the previous 12 months. In all, 6% of the adolescents had tried cigarette smoking at least once, while 41% reported having tasted alcohol drinks. Multivariate regression analyses showed that perceived dental health status and needs were associated with gender, age, unhealthy lifestyles, poor school performance, and socio-economic status. The establishment of school-based health promotion programs in China is urgently needed, and promotion of oral health lifestyles should be integrated with other general health actions.     

Perception of oral health needs by Southeast Iowa non-dental health care providers

The purposes of this dental study were to identify, among non-dental health care providers and administrators, (1) those reasons assessed to be most persuasive in adopting selected dental preventive practices, (2) barriers perceived to be present for their clients to obtain dental services, and (3) practices which would make dental services more available to their clients. A nine-item dental care/attitude survey was completed by 82% (n = 68) of the health care and social services providers/administrators attending one of the United Way of East Central Iowa group meetings. The results of this survey indicated that, for these respondents, the most persuasive reasons for adopting preventive dental practice behaviors were based on susceptibility to disease and social and esthetic benefits. Further, the results of this survey showed that female respondents gave significantly higher scores than males to the importance of social benefits (self-worth and employment marketability), health benefits, and the importance that authority figures (dentists and physicians) placed on the behavior. Fifty-one percent of the respondents knew of patients who had problems obtaining dental services. The main reasons given for clients' access problems were the lack of money, the lack of insurance, and the lack of transportation.     

Locus of control beliefs predicting oral and diabetes health behavior and health status.

Our study evaluates the correlation between dental and diabetes locus of control beliefs and the potentiality of locus of control beliefs in predicting oral health behavior, dental status, diabetes compliance, and HbA1c level by using situation-specific locus of control scales and considering the value dimension. Data were collected by means of a quantitative questionnaire, a clinical oral examination and patient records. The research population comprised 149 insulin-dependent diabetics who had teeth of their own. Variables were the frequencies of tooth brushing and dental visiting, oral indexes, diabetes adherence, and HbA1c level. Dental and diabetes locus of control beliefs correlated with each other. Dental locus of control associated with frequency of dental visiting, plaque index, decayed surfaces, and with root caries, but diabetes locus of control associated only weakly with adherence with diabetes self-care regimens and not at all with HbA1c level. Correlations between dental locus of control and oral indexes were stronger among those having high value for dental care. Although there were correlations between dental and diabetes locus of control beliefs, only dental locus of control beliefs are practicable for determining health behavior and health status. It is therefore concluded that locus of control beliefs are health behavior specific.     

Utilization of dental health services by Danish adolescents attending private or public dental health care systems

The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative systems. The study comprised 1,245 adolescents from 3 municipalities; the historical cohort study design was applied; and data were collected from dental records (public dental service) and dental claims (private practice). At age 16, 12% preferred being enrolled in the private practice system, while 88% remained in the public dental care system. During the 2-year study period the attendance rate was 99% for the public system, while 90% attended the private practice system (P< 0.001). Preventive dental services were provided more frequently by the public than the private system (P< 0.001). Despite the fact that the economic barrier was eliminated a lower attendance rate was observed for patients transferred to the private practice system.     

Utilization of dental health services by Danish adolescents attending private or public dental health care systems

The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative systems. The study comprised 1,245 adolescents from 3 municipalities; the historical cohort study design was applied; and data were collected from dental records (public dental service) and dental claims (private practice). At age 16, 12% preferred being enrolled in the private practice system, while 88% remained in the public dental care system. During the 2-year study period the attendance rate was 99% for the public system, while 90% attended the private practice system (P < 0.001). Preventive dental services were provided more frequently by the public than the private system (P < 0.001). Despite the fact that the economic barrier was eliminated a lower attendance rate was observed for patients transferred to the private practice system.     

Oral health provisions in U.S. health care reform

BackgroundDuring 2009, both chambers of the U.S. Congress passed health care reform bills that contained a variety of provisions specific to oral health and dental care. In March 2010, the Senate version—the Patient Protection and Affordable Care Act (referred to as the Affordable Care Act [ACA])—was signed into law.MethodsThe authors establish the context for ACA dental provisions by reviewing prior federal legislation pertaining to dental coverage. They analyze the final U.S. House and Senate health care reform bills for their oral health content and draw observations regarding congressional interest in oral health.ResultsThe authors identify and describe more than 30 provisions of direct relevance to dentistry within the domains of insurance coverage, dental workforce, safety net, prevention and surveillance. Although the two bills differed in many details, both address oral health infrastructure and delivery of care, with particular attention to underserved child and adolescent populations.ConclusionsThe oral health provisions in the health care reform bills evidenced strong congressional interest in oral health and dental care, with an emphasis on equitable care for children.Practice ImplicationsThe effect of each congressional action on the future of dental practice will depend on how the provisions are regulated and implemented. The dental profession needs to recognize the strong and ongoing interest of lawmakers in oral health care and must maintain active engagement in the policymaking process.     

Interprofessional educational partnerships in school health for children with special oral health needs

Dental caries is an infectious yet preventable disease that is rampant in some subpopulations in the United States, in particular among individuals with neurodevelopmental/intellectual disabilities (ND/ID). This article reports on the implementation and evaluation of the Louisiana State University Health Sciences Center (LSUHSC) School of Dentistry interprofessional school health educational model to improve oral health assessment and referral for children with ND/ID in an inner-city school system. During this project, dental hygiene students and elementary school nurses were paired to assess the oral health status of 255 inner-city children with developmental disabilities, improve referral/access to dental care for those identified as having need, and propose dental hygiene curriculum changes that would incorporate participation in a "real-life public health setting" for those with ND/ID. Following the program, 66 percent of dental hygiene students said their likelihood of participating in future oral health programs had increased and 75 percent of school nurses rated the educational process as very good or excellent. Modifications in dental hygiene curricula that provide students with training and experience in oral health risk assessment and referral for people with ND/ID is recommended to address the new Commission on Dental Accreditation educational standards 2-18 and 2-26 (implemented January 1, 2005) and dental standard 2-26 (implemented January 1, 2006), which state that dental hygiene and dental graduates must be competent in assessing the treatment needs of patients with special needs.     

Eating disorders in women's oral health

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge-eating disorder are a serious concern in women's oral health and a clinical challenge to dental professionals. Each of these eating disorders presents with unique patterns of psychologic, medical, and dental characteristics. Appropriate dental treatment is based in the multidisciplinary facets of these conditions. The dental team should be mindful that individuals who suffer from these disorders may relapse into previous negative eating behaviors. The knowledgeable dental professional may be able to intercept these habits through regular recall intervals and thorough examination.     

Study on availability of dental health services for children in health center--correlation between attendance of 3-year-old children at dental health services and caries prevalence]

The purpose of this study was to evaluate the dental health services for children in a health center. The samples were 316 children who had 3-year-old dental examination at a health center in Tokyo. The analysis was carried out by a computer using the results of the children's oral status and of their mothers', questionnaires and past records showing when and how many times they had attended such activities. The results were as follows: 1. Attendance of children at dental services showed the effectiveness in preventing dental caries, and it was suggested that attendance at least 3 times before the age of 18 months should be the most effective way to decrease the dental caries in the 3-year-olds. 2. According to the questionnaires, time of going to bed, snacks time, and the habit of thumb-sucking at the age of 3 years, and stopping the habit of bottle-feeding and of night breast-feeding at 18 months of age showed a great correlation concerning the number of dental caries in the 3-year-olds. 3. The more often the children had attended the dental services, the more often their behavior for eating snacks and toothbrushing changed for the better. 4. The more the mothers had dental caries, the more was the number of dental caries in their children and moreover their attendance at the dental services was less.     

The advantages of including dental public health in schools of public health in the United States

This paper describes the history and current status of schools of public health and graduate level programmes in dental public health in the United States. The broad core curricula for all public health students undertaking a course for a master's degree in public health is outlined, as well as the specialised course offerings available to dental public health students. The advantages and disadvantages of including dental public health programmes in schools of public health, instead of in dental schools, are discussed. There is a need for the integration of activities between dental schools and schools of public health to alleviate the traditional isolation of dentistry and prevent the omission of dentistry in health policy formation. When possible, the inclusion of the dental public health programmes in schools of public health is recommended so that public health and dental public health students can learn about each other's disciplines and share a common educational experience.     

Geriatric oral health issues in Australia

Aim : To identify and discuss geriatric oral health issues in Australia. Methods : A discussion of the demographic trends, oral health trends, and barriers to dental care for older Australians is presented, together with a review of Australian public and private sector geriatric dental services, geriatric dental research, and geriatric dental education. Conclusions : Key geriatric oral health issues for Australia include: edentulism is decreasing and older Australians are retaining more natural teeth; coronal and root caries are significant problems, especially as older adults become more functionally dependent, cognitively impaired, and medically compromised; the oral health status of institutionalised older Australians is poor; the onset of severe oral diseases appears to occur in many older Australians prior to their institutionalisation, when they are homebound and dependent upon carers; carers of older adults do not have access to practical education about dental care; the majority of older Australians are eligible to use public‐funded dental services, but barriers limit their access to these services; few Australian public or private dental services are designed with a geriatric focus; geriatric dental education does not have a high profile in Australian dental schools; no specialty exists in Australia for geriatric dentistry, nor is there a national geriatric dentistry association.     

Evaluation of governmental dental health services in rural health centers in Egypt

The aim of the study was to identify and evaluate the existing utility of rural oral health services after 20 yr of implementing the compulsory law of rural health services in Egypt. Six out of 26 governorates present in Egypt were selected. Ten rural health centers from each governorate were visited. A review from each center was performed about the demographic features of the village, the dental manpower and type and condition of dental equipment. The existing records of the dental treatment performed per year from July 1980 to June 1981 were recorded. The general findings revealed that only 31% of rural health centers of the selected governorates had dental facilities. The demand for dental treatments in these centers varied between the six governorates and ranged between 12% in Alexandria to 1% in Dakahlia of the population. Most of the treatments performed were extractions (52.52%), while conservative treatments were minimal (0.85%). Prosthetic treatments were not available in these centers.     

Dental public health administration and programming

After a period of teaching dental sociology at the University of Detroit's School of Dentistry, Dr. Hoffmann migarated to Santa Fe as the dental director of New Mexico. With an abundant supply of sociological notions and experience to guide him, he now reports his notions of dental programming and dental administration in action.     

Improving oral health in Pakistan using dental hygienists

This paper reviews the healthcare system, available dental care, and oral health status of people in Pakistan. Considering the enormous unmet oral health needs, the insufficient supply of dental professionals and the current unstructured dental hygiene curriculum in Pakistan, a mission, vision, and goals for professional dental hygiene in Pakistan is recommended. The authors offer recommendations for competency-based dental hygiene education and practice, professional credentialing, a practice act, and a dental hygiene scope of practice to promote the health, welfare, and quality of life of the Pakistani people. Specifically, the authors recommend increasing the number of quality dental hygiene programs, establishing the dental hygienist as a primary care provider of oral health services, enhancing current dental hygiene curriculum, and establishing a dental hygiene council with responsibility for educational requirements and regulation of dental hygienists in Pakistan.     

Dental health and functional ageing

Functional ageing, including dental health, was studied in the gerontological population study in Gothenburg. This study was based on three 70-yr-old cohorts, born in 1901-2, 1906-7, and 1911-12 (n = 1380). The Eichner index was used as a measurement of deterioration in dental state and dental functional impairment. This impairment was significantly associated with a lower capacity in cognition, visual ability, hearing ability, lung volume, heart volume, muscle strength, and bone mineral content as well as a lower self-assessment of health. A multiple regression model showed that an index of seven functional capacities was the most predictive factor for dental status independent of confounding factors such as socioeconomic factors, tobacco smoking, and the most incapacitating diseases. These associations were more marked in men and the survival rate between 70 and 79 years of age was higher among men with a well preserved dental state of the age of 70. The co-variation between impairment in dental function and other functional variables and survival indicate a common functional ageing.     

Social inequalities in dental health

The analysis of social inequality is one of the predominant concerns of sociology. Inequalities in general health or utilization of health care services are nearly universal. The purpose of the paper is to describe inequalities in dental health in Denmark. Recent empirical findings are reviewed. Longitudinal data on the number of adults with few or no teeth left show remarkable differences between low and high social classes in 1976 and 1986. Among the younger individuals some reduction in the social differences has been observed over time. This was ascribed to the establishment of a public child dental health service. The level of dental caries and unmet treatment need is higher among workers than officials. Studies of industrial workers also indicate that dental illness or diseases are induced by environmental working factors. The association between health-related behavior and dental health status has been demonstrated as well as the effects of social network relations and lifestyle. Finally, theoretical explanations of the inequalities in dental health are outlined: artefact explanations, theories of natural or social selection, materialist or structuralist explanations, and cultural/behavioral explanations. Arguments for the relevance of the materialist/structuralist and the cultural/behavioral approaches are given and a combined model on dental health is presented. The practical implications of the various models are discussed.     

Relationship of depressive symptoms to edentulousness,dental health,and dental health behavior

We investigated the relationship of edentulousness, dental health, and dental health behavior to depressive symptoms in the 55-year-old population of Oulu (a medium-sized Finnish town), 780 of whom (78%) participated. The dental examination included an assessment of oral health status. Depressive symptoms were determined with the Zung Self-Rating Depression Scale (ZSDS). The participants were also asked about their dental health behavior, smoking habits, health, life satisfaction, and factors related to their work. Depressive symptoms were associated with edentulousness among non-smoker men. When further evaluated by logistic regression analysis, edentulousness was independently associated with depressive symptoms in this subpopulation (odds ratio = 6.4, confidence interval = 1.4–29.2) after adjusting for confounding factors. Depressive symptoms were not associated with dental caries, periodontal status, or number of teeth. The dentate women with high rates of depressive symptoms had a more negative attitude towards preserving their natural teeth, used sugary products more frequently, reported a longer time since their last dental visit, and tended to have a lower percentage of filled tooth surfaces than the non-depressed dentate women. The aspect of depression should be borne in mind by dentists when treating edentulous patients. On the other hand, certain subgroups of depressed patients might benefit from dental implant therapy. Thus, the importance of teamwork between clinicians, psychiatrists, and dentists is emphasized.