Transcript Dental Public Health

Dental Public Health
Dental Public Health
Introduction
Topics
Historical Development
Dental Care Delivery
in the United States
around the world
Financing Dental Care
Legislative Initiatives
Education and Promotion
Target Populations
Lesson Plan
Program Planning
Program Evaluation
Oral Epidemiology
Research Methods
Biostatistics
Evaluation of Literature
and Products
Careers in the Government
Entreprenurial Initiatives
Board Review
The Prevention
Movement
Dental Hygiene’s Relation
to Dental Public Health
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
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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
In the United States
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
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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
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Operating Division
Human Services
Operating Division
Public Health Service
Operating Division
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National Institutes
of Health
Food and Drug
Administration
Centers for Disease
Control and
Prevention
Agency for Toxic
Substances and
Disease Registry
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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
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Centers for Medicaid
and Medicare
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Medicaid
Medicare
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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
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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
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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
fee-for-service.
Discounted coverage
available and sliding
scales for certain
patients in certain
clinics
Capitation Method
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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
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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
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Dental Billing
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Claim Form
ADA CDT
Payment Plans
Dental Credit Cards
Explanation of
Benefits
Government Role
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Research
Disease Prevention
Disease Control
Program Planning and Operation
Funding for the Education of
Dental Professionals
• Regulation
Government’s Role
• U.S. PHS
• Federal Block
Grants
• State Governments
• Local Governments
Medicaid
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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
• 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
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Related Dental
Professionals
Regulation of Dental
Hygienists
Independent
Practice
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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
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Legislative
Executive
Judicial
Major Bodies of Law
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Common Law
Statutory Law
Constitutional
Law
Administrative
Law
Laws Pertaining to Dental
Hygiene
• State Dental Hygiene
Practice Act,
sometimes referred to
as the statute
• Supervision Status
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
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Related Dental
Professionals
Regulation of Dental
Hygienists
Independent
Practice
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Portability of
Licensure
Future of Dental
Hygiene
Dental Health
Education and Promotion
Health Education Principles
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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
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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. 
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
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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
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Self-Actualization
Need for Self-Esteem
Belongingness and
Love
Safety Needs
Physiological Needs
Behavioral Conditioning
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Classical
Conditioning
Operant
Conditioning
Modeling
Lesson Plan
Development
Assessment Phase
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Assess target populations’
needs
 interests
 abilities
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Assess resources
Dental Hygiene Diagnosis
Formulate Findings
from Assessment
into a Diagnosis.
Prioritize Goals.
Planning
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Broad Goal
Formulation
Specific Objectives
Select Teaching
Methods.
Implementation
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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
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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
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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
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Assessment
Population’s dental needs
 Demographics
 Facility
 Personnel
 Existing Resources
 Funding
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Dental Hygiene Program
Planning Paradigm, Continued
Dental Hygiene Diagnosis
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Prioritization of needs
Formulation of diagnosis to provide goals and
objectives for blueprint
Planning
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Methods to measure goals
Blueprint
Address constraints and alternatives.
Dental Hygiene Program
Planning Paradigm, Continued
Implementation
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Program will begin operation.
Revision and changes identified and
employed
Evaluation
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Measuring goals
Qualitative and quantitative evaluation
Ongoing revisions employed
Program Evaluation
Dental Public Health
Program Evaluation
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Program Planning → Objectives
Measurement of Objectives
Formative
Summative
Evaluation Techniques
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Traditional Nonclinical Measurements
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Interviews
Surveys
Clinical Methods
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Basic
BSS
Dental Indexes
Government’s Evaluation
• Healthy People 2010
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Objectives and
Evaluation
Mechanisms
NOHSS
Call to Action
Oral Epidemiology
• Study of Oral Diseases
• Multifactorial Nature of Disease
• Terminology
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Epidemic
Endemic
Pandemic
Disease Rates
Mortality
Morbidity
Prevalence
Incidence
Etiology
Surveilance
Risk Factors
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
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Historical
Descriptive
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Survey
Observational
Case Studies
Correlational
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Epidemiological
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Longitudinal
Cross-sectional
Retroactive
Experimental
(Prospective)
Quasi-experimental
Beginning Research
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Research Question
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Positive Hypothesis
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Does Brand X toothpaste whiten teeth?
Brand X toothpaste does significantly
whiten teeth.
Null Hypothesis
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There is no statistically significant
difference between Brand X and a placebo
when comparing the whitening of teeth.
Research Design
Formulating a hypothesis
 Review of the literature
 Methods and materials
 Statistical evaluation
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Experimental Approaches
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Two group pretest/post-test designs
Time series
Post-test only
Solomon three and four group
Factorial
Placebos
Control groups
Sampling Techniques
Randomization
Systematic
Convenience
Stratifying
Informed Consent
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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
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Gaussian Distribution
Bell-Shaped Curve
Skewed Data
Graphing Data
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Frequency
Distribution Table
Grouped Frequency
Table
Bar Graph
Histogram
Polygon
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East
West
North
20
10
0
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Correlation
 Correlation
Coefficients
 Positive Correlation
 Negative
Correlation
 Strong Correlation
Correlation
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Pearson Product Movement Correlation
Coefficient
Spearman Rank-Order Correlation
Coefficient
Statistical Decision Making
► Probability
► Type
I Error
► Type II Error
► Degrees of Freedom
Inferential Statistics
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Parametric Inferential Statistics
Student t-test
 Analysis of Variance
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Nonparametric Inferential Statistics
Chi Square Test
 Other Nonparametric Tests
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Interpretation of Data
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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.
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Evaluation of
Scientific Literature and Dental
Products
Regulation of Dental Care
Products
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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
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Introduction
Purpose
Research Design
Sample Selection
 Product Usage
 Examiners
 Statistical
Significance
 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
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Commissioned Officer
Positions
Civil Service Positions
National Health Service
Corps
Other Options
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Independent Contractor
Employee of Dental Staffing Agency
Student Opportunities
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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
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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
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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
Dental Public Health:
Contemporary Practice
for the Dental Hygienist:
“The Dental Hygienist is the Premier
Dental Public Health Provider. “