Transcript 03. Characteristics of dental health

Social Medicine and Health Care
Organization as a science
Historical Development
• Dental Hygiene as
Forerunner to the
Prevention Movement
• Dr. Alfred Fones
• Founder of Dental
Hygiene School and
First Author of Dental
Hygiene College
Textbook
Historical Development
Continued
Practice Settings
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Schools
Industry
Military
Hospitals
Professional
Organizations
Preventive Modalities
Dental Hygiene Treatment
Fluoridation
Xylitol
Dental Sealants
Oral Cancer Exams and Tobacco Cessation
Nutritional Counseling
Atraumatic Restorative Treatment (ART)
Mass Education/Media
Dental Care Delivery
Vehicles of Dental Care
in the United States
FEDERAL
Departments of the
Federal Government
NONGOVERNMENT
Private Practice
Institutions, Schools
Insurance-Based Models
STATE
Departments of State
State Prisons
Community Clinics, Schools
Dental Public Health
The oral health care and education,
with an emphasis on the utilization
of dental hygiene sciences,
delivered to a target population
Factors Affecting Dental Health
• Access to Care
– Restriction of dental
hygiene services
– Shortage of Medicaid
providers
– Financial Situations
• Insurance
• Medicaid
– Transportation
Factors Affecting Dental
Health, Continued
• SES Relation to
Dental Health
• Dental Hygiene
Sciences
• Increase in the
Geriatric Populations
• Malpractice
• Insurance Changes
Federal Influence
Executive Branch
System
Legislation
Senate and House of
Representatives
Executive
President and
Cabinet
Judicial
Federal Court
Department of Health and Human
Services
• Public Health Service
Operating Division
• Human Services
Operating Division
Public Health Service Operating
Division
• National Institutes of
Health
• Food and Drug
Administration
• Centers for Disease
Control and
Prevention
• Agency for Toxic
Substances and
Disease Registry
• Indian Health Services
• Health Resources and
Services Administration
• Agency for Health Care
Policy and Research
• Substance Abuse and
Mental Health Services
Administration
Human Services Operating
Division
• Centers for Medicaid and
Medicare
– Medicaid
– Medicare
• Administration for
Children and Families
• Administration on Aging
Public Health Service
• PHS works toward
improving and
advancing the health of
our nation.
• U.S. Surgeon General
• Dental Hygienists work
as Public Health
Officers.
Other Federal Departments
Influencing Dental Care
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Agriculture
Defense
Education
Justice
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Labor
State
Treasury
Veteran’s Affairs
United States Peace
Corps (which is an
executive branch
agency)
Individual State Influence
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State Dental Divisions
Medicaid
S-CHIPS
Prisons
Tribal Clinics
Institutions
Community Clinics
Dental Health Care Personnel
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Need
Demand
Utilization
Supply
Dental Hygiene
Shortages
• Dental Hygienist
to Dentist
Employment
Ratio = 1:2
Dental Finance
Public and Private
Funding of Dental Care
Historical Funding of Dental
Care
Patient’s Responsibility
The Advent of Dental
Insurance
Medicaid Coverage for
Dental Services
Today’s Dental Financing
Payment Methods
Fee-for-Service
Capitation Plans
Encounter Fee Plans
Barter System
Fee-for-Service
• A dental practice sets a
fee, and a patient and/or
third party pays for the
fee.
• UCR: usual, customary
and reasonable fee
• Indemnity plans pay feefor-service.
• Discounted coverage
available and sliding
scales for certain patients
in certain clinics
Capitation Method
Dental Managed Care
A certain amount is paid to a dental practice for a certain
number of patients. Payment is received whether
treatment is provided or not.
Many times employees will state that they are not paid for
“cleanings” provided; however, this is not an accurate
statement.
Encounter and Barter
• Encounters are for an
arrangement paid for
each visit.
• Barter system is used
when the dental
provider negotiates
payment by exchanging
goods and services.
Insurance Plans
Dental Service Corporations
Health Service Corporations
Preferred Providers Organizations
Individual Practice Associations
Capitation Programs
Dental Billing
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Claim Form
ADA CDT
Payment Plans
Dental Credit Cards
Explanation of Benefits
Government Role
Research
Disease Prevention
Disease Control
Program Planning and Operation
Funding for the Education of Dental Professionals
Regulation
Government’s Role
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U.S. PHS
Federal Block Grants
State Governments
Local Governments
Medicaid
Title XIX
State/Federal
Program
Your State’s
Medicaid Program
Other State’s
Medicaid Program
Dental Care Delivery
Around the World
International Dental Health Care
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Dental Diseases
Historical Perspective
Demographics and the Dental Hygienist
Global Education of the Dental Hygienist
The Role of the Dental Hygienist
Access to Care in Other Countries
International Dental Health Care,
Continued
• Dental Public Health
Programs and Campaigns
• Oral Health Policies
• Lobbying Groups
• International Dental
Organizations
International Overview
• Related Dental
Professionals
• Regulation of Dental
Hygienists
• Independent Practice
• Portability of
Licensure
• Future of Dental
Hygiene
Legislative Initiatives Affecting
Dental Hygiene Practice
In the United States
Issues in the United States
Preceptorship/Alternative
Education
On-the-Job Training for
Supragingival Scaling
Restrictive Supervision Laws
Affecting Access to Care
Advanced Dental Hygiene
Practitioner
State Governments
• Legislative
• Executive
• Judicial
Major Bodies of Law
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Common Law
Statutory Law
Constitutional Law
Administrative Law
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Laws Pertaining to Dental
Hygiene
State Dental Hygiene
• Supervision Status
Practice Act, sometimes
referred to as the statute
State Dental Board
Administrative Law
Governs Dental Hygienists and the
Practice of Dental Hygiene
Rules and Regulations
Self-Regulation
Supervision Types
• Unsupervised
• Independent Practice
• Collaborative Practice
• General Supervision
• Indirect Supervision
• Direct Supervision
International Overview
• Related Dental
Professionals
• Regulation of Dental
Hygienists
• Independent Practice
• Portability of
Licensure
• Future of Dental
Hygiene
Dental Health
Education and Promotion
Health Education Principles
Five Dimensional
Health Model
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Physical
Mental
Social
Spiritual
Emotional
Dental Health Education
• Goal: to prevent dental
diseases utilizing
appropriate dental
health interventions
Health Education Principles
Health Education: the
education of health
behaviors that bring an
individual to a state of health
awareness
Health Promotion: the
informing and motivating of
people to adopt health
behaviors
Health Behavior: an action
that helps prevent illness and
promotes health for a
population
Goals of Dental Health Education
Provide Effective Dental Health Education.
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Change Values Aimed at Improving Health.
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Healthy Behaviors 
Stages of Learning
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Unawareness 
Awareness 
Self-Interest 
Involvement 
Action 
Habit
Transtheoretical Model
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Precontemplation
Contemplation
Preparation
Maintenance
Action
Theory of Reasoned Action
Attitude toward the
behavior
Subjective norms
Perceived behavioral
control
Intention
Behavior
Social Cognitive Theory
Self-Efficacy
Theory
Knowledge –
Behavior –
Environment
Empowerment Models
Participant
Oriented
Social
Environments
Motivation
Motivation
is the will
of the
individual
to act.
Maslow’s Heirarchy of Needs
Self-Actualization
Need for Self-Esteem
Belongingness and Love
Safety Needs
Physiological Needs
Behavioral Conditioning
Classical
Conditioning
Operant
Conditioning
Modeling
Lesson Plan
Development
Assessment Phase
Assess target populations’
• needs
• interests
• abilities
Assess resources
Dental Hygiene Diagnosis
• Formulate Findings
from Assessment into a
Diagnosis.
• Prioritize Goals.
Planning
• Broad Goal Formulation
• Specific Objectives
• Select Teaching
Methods.
Implementation
• Be Prepared.
• Effective Teacher
Characteristics
Evaluation
Qualitative
Measurement
Quantitative
Measurement
Information
Provided to
Appropriate Parties
Target Populations
For the Practicing Hygienist
Target Populations
A group of individuals with
similarities of some sort whether it be
age, race, educational background,
life situations, and/or health
conditions
Specific Target Populations
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Family Caregivers
Health Care Workers
Hospice Workers
Persons with
Medical Conditions/
Diseases
• Developmentally
Disabled
• Hearing Impaired
• Visual
Impairments
• School Teachers
• Social Workers
• Ages
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Prenatal
Infancy
Children
Adults
Older Adults
Cultural Diversity
The social, ethnic, and cultural
elements that compose a person.
Barriers to Dental Hygiene and
Dental Care
Age
Language
Habit
Culture
No Finances
Lack of Faith
Education
Misunderstanding Fear
Transportation
Values
Safety
Illiteracy
Attitudes
Denial of Disease
No providers
Invulnerability
Convenience
Social Issues
Education Levels
Provider Conflicts
Program Planning
For the Dental Hygienist
What is a dental public health
program?
Educational, clinical, and referral
services to a target population
Preventive Programs
School Fluoride Mouthrinse Programs
School Dental Sealant Programs
Xylitol Programs
Mouthguard Programs
Dental Health Educational Programs
Tobacco Cessation Programs
Denture Identification Programs
Dental Public Health Programs
Healthy Smile
Program
Inner City
Health Center
Dental Program
Soroptomist
Dental Project
Matthew 25
Operation
Smile
Dental Hygiene Program
Planning Paradigm
Assessment
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Population’s dental needs
Demographics
Facility
Personnel
Existing Resources
Funding
Dental Hygiene Program
Planning Paradigm, Continued
Dental
Hygiene
Diagnosis
Planning
• Prioritization of needs
• Formulation of diagnosis to provide
goals and objectives for blueprint
• Methods to measure goals
• Blueprint
• Address constraints and alternatives.
Dental Hygiene Program
Planning Paradigm, Continued
Implementation
Evaluation
• Program will begin operation.
• Revision and changes identified and
employed
• Measuring goals
• Qualitative and quantitative
evaluation
• Ongoing revisions employed
Program Evaluation
Dental Public Health
Program Evaluation
Program Planning → Objectives
Measurement of Objectives
Formative
Summative
Evaluation Techniques
Traditional
Nonclinical
Measurements
Clinical
Methods
• Interviews
• Surveys
• Basic
• BSS
• Dental Indexes
Government’s Evaluation
• Healthy People 2010
Objectives and
Evaluation Mechanisms
• NOHSS
• Call to Action
Oral Epidemiology
Study of Oral Diseases
Multifactorial Nature of Disease
Terminology
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Epidemic
Prevalence
Endemic
Incidence
Pandemic
Etiology
Disease Rates Surveilance
Mortality
Risk Factors
Morbidity
Index
Oral Epidemiology Reports
Morbidity and Mortality
(MMWR)
Healthy People Reports
Surgeon General’s Report
Call to Action
Global Oral Data Bank
Epidemiology of Oral Diseases
Periodontal Diseases
Tooth Loss
Dental Caries
Oral Cancer
Cleft Lip/Palate
Injury
Toothaches
Research
In Dental Hygiene
Significance of Research to
Dental Hygiene
Dental public health is based upon
programs that have demonstrated
effectiveness in achieving health for
the population.
Types of Research
• Historical
• Descriptive
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Survey
Observational
Case Studies
Correlational
• Epidemiological
– Longitudinal
– Cross-sectional
• Retroactive
• Experimental
(Prospective)
• Quasi-experimental
Beginning Research
Research
Question
• Does Brand X toothpaste whiten teeth?
Positive
Hypothesis
• Brand X toothpaste does significantly
whiten teeth.
Null
Hypothesis
• There is no statistically significant
difference between Brand X and a placebo
when comparing the whitening of teeth.
Research Design
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Formulating a hypothesis
Review of the literature
Methods and materials
Statistical evaluation
Experimental Approaches
Two group pretest/post-test designs
Time series
Post-test only
Solomon three and four group
Factorial
Placebos
Control groups
Sampling Techniques
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Randomization
Systematic
Convenience
Stratifying
Informed Consent
• Informed Consent is part of examining the
ethics of the research project as a whole.
Dental Research
Biostatistics
Categorizing Data
• Discrete or Continuous
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Nominal
Ordinal
Interval
Ratio
Descriptive Statistics
Measures of Central Tendency
• Mean
• Median
• Mode
Measures of Dispersion
• Range
• Variance
• Standard Deviation
The Normal Distribution
Gaussian
Distribution
BellShaped
Curve
Skewed
Data
Graphing Data
• Frequency Distribution
Table
• Grouped Frequency
Table
• Bar Graph
• Histogram
• Polygon
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East
West
North
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10
0
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Correlation
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Correlation Coefficients
Positive Correlation
Negative Correlation
Strong Correlation
Correlation
Pearson Product
Movement
Correlation
Coefficient
Spearman RankOrder Correlation
Coefficient
Statistical Decision Making
Probability
Type I Error
Type II Error
Degrees of Freedom
Inferential Statistics
Parametric
Inferential
Statistics
• Student t-test
• Analysis of Variance
Nonparametric • Chi Square Test
Inferential
• Other Nonparametric Tests
Statistics
Interpretation of Data
• Statistical Significance
• Clinical Significance
Research Results
Validity: Results of the study can be inferred to
the general population.
Reliability: The study was conducted in a
controlled manner and if repeated would lend
the same results; thus, the study is reproducible.
Evaluation of
Scientific Literature and Dental
Products
Regulation of Dental Care Products
• Food and Drug
Administration
• American Dental
Association Seal of
Acceptance
Dental Hygienist’s Role
• Critical consumer
• Patient education
• Awareness of
advertising techniques
Evaluation of Scientific
Literature
Introduction
Product Usage
Purpose
Examiners
Research Design
Statistical Significance
Sample Selection
Results
Careers in
Dental Public Health
Positions for the RDH
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U.S. PHS
VA Hospitals
Federal Prisons
Military Base Clinics
Other Agencies
United States RDH Positions
• Commissioned Officer
Positions
• Civil Service Positions
• National Health Service
Corps
Other Options
Independent Contractor
Employee of Dental Staffing Agency
Student Opportunities
• COSTEP
Strategies for Creating Dental
Hygiene Positions
In Dental Public Health Settings
Populations
Homebound
Institutionalized
Populations with Disabilities
Rural Area Residents
Population with Dental Phobias
Populations faced with Language or Cultural Barriers
Patients without Financing
Proposed Plan for Action
Dental Hygiene Program Planning
Paradigm
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Assessment
Dental Hygiene Diagnosis
Planning
Implementation
Evaluation
Practice Management Issues
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Patient tracking
Appointment scheduling
Practice promotion
Collection of fees
Proposal Development and
Presentation
• Introduction
• Significance of Position
• Blueprint of the
Operational Program
• Conclusion
• Contracts
• Teaching Strategies
Dental Public Health
Review
Community Health/Research
Principles
Promoting health and
preventing disease within
groups
Participating in community
programs
Analyzing scientific
information, utilizing
statistical concepts, and
applying research results
Thank you!