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MFD Theme 2b Flashcards

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1
Q

what is epidemiology

A

the scientific method of studying diseases in populations.

orderly study of diseases and conditions where the group and not the individual is the unit of interest.

study of the distribution and determinants of disease frequency in human populations.

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2
Q

what are the examples of epidemiology in dentistry

A

measurement of dental disease in populations & subgroups

evaluation of the effectiveness of treatments

assessment of needs and demands within the community

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3
Q

what are the 3 components of epidemiology

A
  1. Distribution
  2. Frequency
  3. Determinants
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4
Q

what is the process of epidemiology

A

suspicion

formulation of hypothesis

hypothesis tested in epidemiological studies with comparison group

Collect and analyse- statistical association

Assess validity of any observed association

Does statistical association suggest a causal relationship?

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5
Q

how can you measure disease to investigate epidemiology

A

Can use indices

Importance of standardisation

Quantification of disease

Need to be objective rather than subjective

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6
Q

what is the Gold standard measure for 12 Dental Disease

A

Valid, reliable, objective, simple to investigate, reproducible, sensitive & acceptable to the patient (i.e. must not cause harm to the patient).

Is everything you measure a true measure of that disease or is it just a proxy

Reproducible for everyone by standardisation and calibration where possible

Must calibrate to the gold standard  we all see the same thing

Sensitive- minute or major improvements in a condition

Acceptable to the patient e.g. periodontal probing (do not press too hard)

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7
Q

what are the types of study design

A

1) Descriptive – observational/ case-reports / case-series / cross-sectional
2) Analytic – observational (case-control/ cross-sectional) OR observational (clinical trials).

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8
Q

what are case studies/series used for

A

Highlighting interesting or novel cases / treatment

Recognition of new disease/outcome

Formulation of new hypotheses

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9
Q

what are the Disadvantages/weaknesses of case studies/series

A
  • Cannot demonstrate valid statistical association

* Lack of appropriate comparison group can obscure a relationship or suggest an association where none exists

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10
Q

what is involved in a cross sectional survey

A

Observation of a defined population at a single point in time (or time interval)

Exposure and outcome are determined simultaneously

Used for measuring the prevalence of a disease/looking at potential risk factors or cause

Adult and children survey every year are a good example

Could be a period of time- still cross sectional

However cannot validate what you’ve been told

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11
Q

what are cross sectional surveys use for

A

Measure prevalence of a disease

look at potential risk factors or cause

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12
Q

what are the disadvantages of cross sectional surveys

A
  • Can’t prove causality  can only link potential association
  • Confounders may be unequally distributed (a confounder is an unobserved exposure associated with the exposure of interest and is a potential cause of the outcome of interest)-
  • Group sizes may be unequal
  • Recall bias (recall something better that happened recently rather than long time ago)
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13
Q

what are cohort studies

A

Involves identification of two groups of patients

  • one which received the exposure of interest
  • one which did not

following these cohorts forward to assess the outcome of interest.

Prospective and work forwards

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14
Q

what are cohort studies used for

A

Measures the incidence of disease

Looking at causes of disease

Determining prognosis

Establishing timing and directionality of events

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15
Q

what are Disadvantages / weaknesses of cohort studies

A

Controls may be difficult to identify

Exposure may be linked to hidden confounder

Blinding is difficult- easy to know what group you’re in

For rare diseases large sample size is often necessary (very small % of people actually have the disease)

Cohort studies should be used for common diseases e.g caries, gingivitis

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16
Q

what are case-control studies

A

A study which involves identifying patients who have the outcome of interest (cases) and patients without the same outcome (controls), and looking back in time to see if they had the exposure of interest.

Look BACKWARDS in time – start with the disease and look back, unlike cohorts

Involves looking at their exposure to carcinogens/teratogens/wood-shavings

Looking then back at dental/medical records & occupations in order to try create a link between those who have the outcome

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17
Q

what are case control studies used for

A

Looking at potential causes of disease (suitable for rare diseases

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18
Q

what are Disadvantages/weaknesses of case control studies

A

Confounders e.g. if you don’t drink tap water, it doesn’t matter if its fluoridated

Selection of controls may be difficult

Recall and selection bias

Difficult to establish time relationships between exposure to the risk factor and development of the disease

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19
Q

difference between case-control study and a cohort study

A

Case control involves investigating individuals who have already been infected with a disease

Cohort involves individuals who are initially disease free before the trial

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20
Q

what are Randomised Controlled Trials (RCTs)

A

Exposure status is assigned by the researcher (preferably by random allocation)

Randomisation is the best way of reducing selection bias between 2 groups of participants.

Best RCTS have qualitative component along-side asking people how they feel

Used for evaluating the effectiveness of an intervention

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21
Q

what are Randomised Controlled Trials (RCTs) Disadvantages:

A

High costs
Ethical issues
Participant compliance – e.g. drop out

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22
Q

what is a systematic review definition

A

The evidence from a number of studies (can be RCTS) can be gathered together in one report which pools and analyses all available data to assess the strength of the evidence

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23
Q

Why conduct a systematic review?

A

Systematic reviews can end confusion / highlight where there is not enough evidence/yield new insights by combining findings from different studies

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24
Q

what is prevalence

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A

The proportion of individuals in a population who have the disease of interest at a specific instant.

Prevalence provides an estimated of the probability (risk) that an individual will be ill at a point in time

25
what is the equation for prevalence
Prevalence = number of existing cases of a disease/total population
26
what is incidence
Quantifies the number of new cases of a disease that develop in a population at risk during a defined time period.
27
what is the equation for cumulative incidence
number of new cases of a disease during given time period /total population at risk
28
what is the equation for incidence rate
number of new cases of a disease during given time period/ total person-time of observation
29
what is an index
A numerical value describing the relative status of a population on a graduated scale with definite upper and lower limits designed to permit and facilitate comparison with other populations classified by the same criteria and methods’.
30
what are the uses of indices
To describe the prevalence of a disease/condition in a population and they can be used to describe the severity of diseases/conditions. To study and compare the health status of individuals and populations To provide data for epidemiological studies For planning oral health policy – OCDO use the data from epidemiological studies to plan the contract To evaluate the success of preventive interventions
31
what are the desirable properties of Indices:
Equally sensitive across the scale, to clinically-relevant changes in disease severity and disease progression. Simple to apply, objective, clear and unambiguous. Should be valid (it should faithfully record the disease/condition it is presumed to identify).  measure what it reports to measure Should be reliable (it should be consistent and repeatable at different times, by the same examiner or group of examiners). The measurements gained should be amenable to statistical analysis. Should be acceptable to the participant (it should not be painful nor cause harm).
32
what is meant by validity
actually measures what test purports to measure dont want to measure a proxy
33
what is meant by reliability
consistency and repeatability in the hands of an examiner or group of examiners
34
what is meant by chance
a possibility/probability of something happening an opportunity subject to random variation
35
what is meant by bias
Inclination or prejudice in favour of a particular person, thing or viewpoint. To influence unfairly A systematic error relating to the measurement of a variable
36
what is cofounding
An error in the interpretation of a measurement (even if the measurement is accurate!) A confounder is prognostically linked to the outcome of interest and is unevenly distributed between the study groups
37
how can cofounding be managed
Randomise Stratify Match Statistical analysis
38
what are Problems with the DMF/dmf Index
M’ and ‘F’ teeth are assumed to have been carious. Missing- could be hypodontia, could be knocked out in an incidence. Filled teeth could be fractured Were past treatment decisions for preventive or restorative reasons? Equal weight is given to ‘D’, ‘M’, ‘F’, yet the implications for dental health are different. Which ones worse?? We treat them the same. ‘F’ teeth score the same as ‘M’ teeth…so what’s the point in having decayed teeth restored? DMF/dmf score is irreversible.
39
what are things that should be considered when looking at the epidemiology of periodontal disease
Who and how many are affected in the population? What is the disease process? Chronic progressive Burst theories What is the aetiology? How can we manage the condition?
40
how is PD measured visually
* Description of tissues * Radiographs * Photographs
41
how is PD measured using indices
* Bleeding on probing * Tooth mobility * Periodontal pocket depths (loss of attachment) * Furcation involvement * Others……?
42
what is the epidemiology of oral cancer
The 14th most common cancer in the UK (in 2012). Incidence of OC in the UK has increased by 34% over the last decade OC mortality rates in the UK have risen by around 10% in the last decade
43
what are established risk factors for oral cancer
* Age, sex * Smoking * Alcohol * Chewing tobacco * Betel quid * Diet * Weakened immune system * Sunlight * Chemicals
44
what are Potential Risk Factors for oral cancer
* Viruses? * Irritation? * Family history? * Mouthwash?
45
what should be considered in Malocclusion / Dentofacial Anomalies
* Minor dental cosmetic irregularity or significant dento-facial disfigurement? * Perspective: patient / family / peers / clinician? * Social and psychological influences * Prioritisation for orthodontic treatment = ‘IOTN’ * Prioritises those who need NHS treatment
46
what is IOTN and why is it used
Index of Orthodontic Treatment Need How to prioritise who receives limited resources according to NEED (not demand) Higher scores = greater need Attempts to address equity issues • Dental Component • Aesthetic Component
47
what are Selected indicators for fluoride monitoring programme
* d3mft/D3MFT (reduced in areas of fluoridation?) * Dental fluorosis (evidence of fluorosis assoc. with F intake, TF score) * Bone health (Hip fracture) * Renal effects (Incidence of kidney stones) * Mortality (all causes, a ‘catch-all’ measurement) * Birth defects (Incidence of Down’s Syndrome) * Cancer: (Bladder/osteosarcoma/overall cancer incidence rate
48
why do we measure DMFT
Introduced as a summary of cumulative caries experience Measures number of teeth that are decayed, missing (due to caries) or filled Usually used in epidemiological studies
49
what are limitations of DMFT
Doesn’t give age Gives equal weight to missing, untreated caries or well restored teeth No measurement of extent of caries- small/deep (un-restorable) Doesn’t consider other disease processes other than caries – does not consider periodontal disease No indication of teeth at risk- may have early carious lesions Sealants or PRRs given same weighting as heavily restored teeth- really small carious lesion in the fissure of a molar would be given the same rating as a heavily restored tooth. Rate of caries progression cannot be assessed Does not represent current treatment need Relies on patient recall – may not remember why a tooth was lost
50
how do you measure DMFT
Score a tooth as 1 if it is: - Decayed - missing (due to caries) - filled Score a tooth as 0 otherwise A few notes: - Provided 3rd molars are included, the score is out of 32 - Be consistent if you are including 8s or not - Do not include teeth missing due to reasons other than caries, e.g: Unerupted, congenitally missing, extracted for orthodontic/periodontal reasons, knocked out through trauma
51
why do we measure plaque
Indicate extent of plaque coverage of teeth Used in epidemiological studies but also useful resource for individual patient care- plaque scores worked out as a %
52
what does the plaque coverage index measure
number of surfaces with plaque present (plaque either present or absent 1.Divide each tooth into 6 areas: 2.Assess whether or not plaque is present on each surface 3.Calculate the percentage of surfaces present with visible plaque.
53
what should not be done when measuring plaque coverage index
Do not score occlusal surfaces. Do not quantify amount of plaque i.e. it’s either present or absent.
54
how is plaque index measured
Plaque index = number of surfaces/ total number of surfaces with plaque x 100%
55
what is the silness and loe plaque index
Used when we want to measure the amount of plaque present on each tooth surface. Like the Plaque Coverage Index, ignore the occlusal surfaces.
56
how is the silness and loe index measured
0 – No plaque 1 – Film of plaque, visible only by removal on a probe 2 - Moderate accumulation of deposits visible with the naked eye 3 – Heavy accumulation of plaque Can divide each tooth into 4 or 6 surfaces For the clinical trial, we will use 6 surfaces tell your nurse which teeth are missing before you chart Then, read out the score for each surface working systematically around dentition like with the Plaque Coverage index
57
how is s&l plaque index calculated
Plaque index = Total S & L plaque score/ Total number of surfaces
58
what cross infection control should be remembered on clinic
Personal Protective Equipment (PPE) Mask, Gloves, Safety Glasses Hair tied back, bare below the elbow Patient Protection Safety glasses, bib Effective Hand Hygiene Clean and dirty zones Disposal of equipment
59
what waste disposals are there and what goes in each
Domestic waste -Paper towels, bits of paper etc. Clinical waste - All gloves - Anything remotely clinical looking e.g. bits of gauze, cotton wool etc. Instruments are not waste! - Return to tray (not in sharps bin!) - Dirty utility room - Tidy up when finished

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