Dental Public Health - Measuring oral health

Question 1

How do we measure oral health?

Answer 1

• Clinical indicies
• Quality of life measures
• OHL

Question 2

Which different factors determine our health (6)?

Answer 2

• Biological
• Social
• Psychological
• Economic
• Cultural
• Environmental

Question 3

What is often forgotten about in the biomedical model of health (2)?

Answer 3

Oral health has a:

• **physical **impact (allows for intake of nutrients and balanced diet, affects diet & speech, can cause pain and discomfort)
• Pshycological impact (appearance, speech, taste, socialising & well-being)

Question 4

What is the relationship between general and oral health?

Answer 4

Bi-directional

(oral health influences general health and vice versa)

Complex

Question 5

What did Cohen and Jago introduce in 1976?

Answer 5

Socio-dental indicators (models of care = how dentists work)

-> acknowledged the role of clinical measures in measuring oral health = could be improved if socio-dental indicators could be included = improve prevention and patient care = positive impact on oral health policy

Question 6

What did Locker (dentist and sociologist) introduce in 1988?

Answer 6

Component model of measuring oral health

-> move away from biomedical approac to one which saw oral health as part of peoples everyday functioning and ordinary life

Question 7

What did locker introdice in 1997?

Answer 7

Oral health and the quality of life

Question 8

What did sheiham & watt introduce in 2000?

Answer 8

Common risk factor approach

= oral health and general healh are shaped by similar issues (oral health is an equal indicator of health to any other e.g. blood pressure)

Question 9

What happens when you don’t treat caries according to lockers model (5)?

Answer 9

• Impairment
• Functional limitations
• Discomfort
• Disability
• Handicap

Question 10

What is impairment?

Answer 10

anatomical loss or structural abnormality = starting to impact on the level of their lives

Question 11

What is Functional limitation?

Answer 11

restriction in the functioning

Question 12

What is discomfort?

Answer 12

self-reported pain and physical and psychological symptoms

Question 13

What is disability?

Answer 13

lack of ability to perform activities of daily life

Question 14

What is handicap?

Answer 14

disadvantage experience by those with impairments

Question 15

What does lockers definition of health take into consideration (3)?

Answer 15

• Physical
• Psychological
• Social (may avoid social interactions because illness makes them self concious = holds them back in life = handicap)

e.g. if present at interviews with bad/missing teeth they are less likely to get a job

Question 16

What is the DoH (1994) definition of oral health?

Answer 16

The standards of health of the oral and related issues which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and which contributes to general well being

Question 17

What is Dolans (1993) definition of oral health?

Answer 17

A comfortable and functional dentition which allows individuals to continue in their desired social role

Question 18

What is lockers definition for the quality of life?

Answer 18

The degree to which a person enjoys the important possibilities of life

i.e. how good is your life for you?

Question 19

Why should we measure oral health?

Answer 19

• ‘silent epidemic’
• most common chronic disease
• millions of children & adults go untreated
• Determinants well known and preventable (diet, hygiene, smoking, alcohol, stress & risky behaviour = trauma/injury)
• Approx. 160 million work hours are lost a year due to oral disease

IF WE MEASURE ORAL HEALTH WE WILL BE BETTER ABLE TO TREAT/PREVENT IT

Question 20

What are the different ways of measuring oral health (2)?

Answer 20

Clinical measures​/Biomedical

• based on the development of indicies
• focus on the identification of disease
• Administer in treatment/patient exam

Oral Health Related Quality of Life (OHRQoL) measures/Social

• Subjective (looks at individual)
• Sees oral health as part of our social and psychological well being

Question 21

What are clinical measures of oral health?

Answer 21

Involves scoring patients on indicies/index = shows prevalence/state of disease in population

E.g.

DMFT (Decayed missing filled teeth)

Helkimo’s index of mandibular symptoms

Community Periodontal Index of Treatment (CPITN)

Question 22

What is an index?

Answer 22

an instrument that enables the quantitiy of disease or a state to be measured

Question 23

Which criteria do we use to assess clinical indicies (8)?

Answer 23

• Simple
• Objective (clear cut categories & easy to put response into options availaible & relate to clinical stages of condition)
• Valid (measure what it intends)
• Reliable (no variation on occasion of result)
• Reproducible
• Quantifiable (a measure that can be statistically analysed e.g. mean & distribution)
• Sensitive (detect small changes & bidirectional)
• Acceptable (not painful, embarrassing, demeaning or take too long to administer)

Question 24

What does DMFT act as a common index for?

Answer 24

Prevalence and severity of dental caries in population

= historical record (records current & previous disease)

3 measures:

Treatment index = (M+F)/DMF X100

Care index = F/DMF X100

Restoritive index = F/D+F X100

Question 25

What are the advantages of using clinical measures of health (3)?

Answer 25

* compare the oral health of different groups at different times * Measure diseases e.g. dental caries, tooth erosion, gum disease * Calculate prevalence & incidence rates of oral diseases (e.g. can express incidence of dental caries as an increase of DMFT over 2 points in time)

Question 26

What are the disadvantages of using clinical measures of oral health?

Answer 26

They only measure oral diseases not oral health i.e. charts biological changes NOT how people are living with the disease

Question 27

Give some examples of Oral Health related quality of life measures (3):

Answer 27

* General oral health assessment index (Atkinson and Dolan 1990) * Dental impact profile * Oral Health impact profile (OHIP)

Question 28

What is the General oral health assessment index?

Answer 28

Patients respond to a range of statements on the functional and psycho-social effects of oral health (e.g. how often do you feel uncomfortable eating in front of people because of problems with your teeth or dentures?) Use likery response rate (0= never to 5 = always)

Question 29

What is the dental impact profile?

Answer 29

* 25 statements (e.g. do you thing that your teeth or dentures have a good, bad or no effect on your eating?) * 4 scales: health/well being, social relations & romance * Overall score is positive or negative

Question 30

What is the oral health impact profile (OHIP)?

Answer 30

49 item measures 7 theoretical domains (functional limitation, pain, pshycological discomfort, physical disability, social disability & handicap) E.g. have you had to interupt meals because of problems with your teeth, mouth or dentres? using the linkert response (0= never to 5 = always) Allows us to perceive the severity of the impacts by calculating the reported negative impacts

Question 31

What are the advantages of using oral health related quality of life measures (3)?

Answer 31

* Allows for screening and monitering of psychosocial problems in individual patient care * Patient designed (the patients are asked what sort of questions should be asked) * Allow us to consider the umpact of a variety of chronic conditions on the patient (the impact on their lives)

Question 32

What are the disadvantages of using Oral Health related quality of life measures?

Answer 32

* Not widely used * Tend to be used among particular groups e.g. the elderly & special care groups only when they thing an extra dimension is required to bring to their care of the patient * SUBJECTIVE * Less likely to be used in clinical setting (long lost of items but shortening of test may impact the reliability of the index (Nunnally 1967))

Question 33

What is the oral health literacy (OHL)?

Answer 33

* Alternative indicator of oral health * degree to which individuals have the capacity to obtain, process and understand basic oral health information and servivces needed to make appropriate health decicisions * Low OHL = associated with poorer oral healt status, dental neglect, infrequent use of dental services and decreases in oral quality of life) * May measure both oral health inequalities & oral health

Question 34

What are the two main ways of measuring oral health?

Answer 34

1. Clinical measures = record and measure biological mechanisms of oral health 2. Quality of life measures = living impacts oral health has in our every day lives