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 Hygienes 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
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

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

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 President and Cabinet Federal Court

Executive

Judicial

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

Agriculture Defense Education Justice

Labor State Treasury Veterans Affairs United States Peace Corps (which is an executive branch agency)

Individual State Influence

State Dental Divisions Medicaid S-CHIPS Prisons Tribal Clinics Institutions Community Clinics

Dental Health Care Personnel

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

Patients Responsibility The Advent of Dental Insurance Medicaid Coverage for Dental Services Todays 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 fee-for-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
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

Governments Role
U.S. PHS Federal Block Grants State Governments Local Governments

Medicaid

Title XIX State/Federal Program Your States Medicaid Program Other States 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

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

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

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

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. Change Values Aimed at Improving Health. Healthy Behaviors

Stages of Learning
Unawareness Awareness Self-Interest Involvement Action Habit

Transtheoretical Model

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.

Maslows 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

Family Caregivers Health Care Workers Hospice Workers Persons with Medical Conditions/ Diseases Developmentally Disabled Hearing Impaired

Visual Impairments School Teachers Social Workers Ages

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 Culture Education Transportation Illiteracy No providers Social Issues Language No Finances Values Attitudes Invulnerability Education Levels Habit Lack of Faith Safety Denial of Disease Convenience Provider Conflicts

Misunderstanding Fear

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
Populations dental needs Demographics Facility Personnel Existing Resources Funding

Dental Hygiene Program Planning Paradigm, Continued

Dental Hygiene Diagnosis

Prioritization of needs Formulation of diagnosis to provide goals and objectives for blueprint
Methods to measure goals Blueprint Address constraints and alternatives.

Planning

Dental Hygiene Program Planning Paradigm, Continued

Implementation

Program will begin operation. Revision and changes identified and employed
Measuring goals Qualitative and quantitative evaluation Ongoing revisions employed

Evaluation

Program Evaluation
Dental Public Health

Program Evaluation

Program Planning Objectives Measurement of Objectives Formative Summative

Evaluation Techniques

Traditional Nonclinical Measurements

Interviews Surveys
Basic BSS Dental Indexes

Clinical Methods

Governments Evaluation
Healthy People 2010
Objectives and Evaluation Mechanisms NOHSS Call to Action

Oral Epidemiology
Study of Oral Diseases Multifactorial Nature of Disease Terminology
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 Generals 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

Epidemiological

Survey Observational Case Studies Correlational

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. There is no statistically significant difference between Brand X and a placebo when comparing the whitening of teeth.

Null Hypothesis

Research Design
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
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
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 Bell-Shaped Curve Skewed Data

Graphing Data

Frequency Distribution Table Grouped Frequency Table Bar Graph Histogram Polygon

90 80 70 60 50 40 30 20 10 0 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr East West North

Correlation
Correlation Coefficients Positive Correlation Negative Correlation Strong Correlation

Correlation

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

Parametric Inferential Statistics

Student t-test Analysis of Variance

Nonparametric Inferential Statistics

Chi Square Test Other Nonparametric Tests

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 Hygienists Role

Critical consumer Patient education Awareness of advertising techniques

Evaluation of Scientific Literature

Introduction Purpose Research Design Sample Selection Product Usage Examiners Statistical Significance Results

Careers in
Dental Public Health

Positions for the RDH

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

Assessment Dental Hygiene Diagnosis Planning Implementation Evaluation

Practice Management Issues

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

Dental Public Health: Contemporary Practice for the Dental Hygienist:

The Dental Hygienist is the Premier Dental Public Health Provider.