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PMHP need to know Flashcards

1
Q

what is the optimal dose of fluoride in drinking water?

A

1ppm
1mg/l

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2
Q

name 2 foods and/or drinks other than water which are good natural sources of fluoride

A
  • fluoridated salt
  • fluoridated milk
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3
Q

list 4 methods of topical fluoride application for an 8 year old

A
  • fluoride varnish 22,600ppm at least 2x per year
  • fluoride toothpaste 1500ppm
  • fluoride tablets 1mg fluoride daily
  • fluoride mouth rinse 225ppm
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4
Q

how does topical fluoride help prevent caries?

A
  • fluoride slows down development of decay by stopping demineralisation of dentine
  • makes enmale more resistant to acid attack from plaque bacteria
  • speeds up remineralisation
  • can stop bacterial metabolism at high concentrations to produce less acid
  • fluoride that enters the tooth produces fluoroxyapatite which makes the tooth much stronger once remineralisation occurs
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5
Q

what daily dose of fluoride tablet would you give to a child…
* age 4 yeats
* high caries risk
* area with <0.3ppm fluoride in water supply

A

o.5mg/day

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6
Q

what is the recommended maximum weekly alcohol intake?

A
  • no more than 14 units per week
  • should be spread evenly over 3+ days
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7
Q

what acts regulate alcohol in Scotland?

A
  • criminal justice and licensing act 2010
  • alcohol etc. act 2010
  • air weapons and liscensing act 2015
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8
Q

what has reduced alcohol consumption in Scotland?

A
  • minimum pricing
  • ban on multi-drink promotions
  • lower drink drive limits
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9
Q

what are the chairside interventions that can be used to help somoene with an alcohol problem?

A
  • 5As (ask, advise, assess, assist, arrange)
  • 2as 1R (ask, advise, refer)
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10
Q

describe what incidence means

A
  • number of new disease cases developing over a specific period of time in a defined population
  • obtained from longitudinal studies or derived from registers
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11
Q

what is the incidence rate?

A

the number of new cases of a disease in a period/number of individuals in the population at risk

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12
Q

define prevalence

A

the number of affected indivduals in a population at a given time
estimates are obtained from cross-sectional studies or derived from registers which can relate to attributes to absence or presence of disease

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13
Q

what does SIMD stand for?

A

scottish index of multiple deprivation

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14
Q

what is the SIMD?

A

an area based index which uses a range of data to decide which neighbourhoods are most deprived by ranking data such as education and employment in order of deprivation from 1-5/10

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15
Q

what are the 7 factors of deprivation measured in the SIMD?

A
  • employment status
  • income
  • health and care services
  • geographic access to services
  • crime
  • housing, living and working conditions
  • education, skiils and training
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16
Q

what are the four key design elements of randomised control trials?

A

specification of participants
control/comparison groups
randomisation
blinding/masking

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17
Q

name an advantage of randomised control trials

A

provide the strongest and most direct epidemiologic evidence for causality

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18
Q

give disadvantages of randomised control trials

A

more difficult to design and conduct than oberservational studies
not suitable for all research questions
high costs
still some risk of bias

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19
Q

what is a cross-sectional study?

A

observational study that analyses data collected from a population, or a representative subset, at a specific point in time

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20
Q

what is a case-series report?

A

description of the medical history of one or more patients

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21
Q

what is a case-control study?

A

people with a disease are matched to those without it and earlier exposure to different factors are compared

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22
Q

what is a cohort study?

A

participants are recruited to a study and followed up over time. Exposures and diseases are measured prospectively

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23
Q

what is a systematic review and meta analysis?

A

all the evidence for RCTs looking at effectiveness of a particular treatment are synthesised

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24
Q

what are case-series reports used for?

A

hypothesis generation
to identify a new disease outcome

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25
what are the disadvantages of case series reports?
cannot demostrate valid statistical associations lack of control group
26
what are cross sectional studies used for?
estimating prevalence of a disease to investigate potential risk factors
27
what are the disadvantages of cross-sectional studies?
recall bias causality confounding factors
28
what are case-control studies used for?
looking at potential causes of a disease
29
what are the disadvantages of case-control studies?
confounding factors recall/selection bias time relationships (did exposure occur before disease)
30
what are cohort studies used for?
estimating incidence of disease investigating cause of disease determining prognosis timing and direction of events
31
what are disadvantages of cohort studies?
controls are difficult to identify confounding factors blinding is difficult need large samples for rare diseases very expensive and time consuming
32
what does a confidence interval do?
tells us the range of values that a true population treatment effect is likely to lie
33
what does a confidence interval that overlaps the value of no difference between treatments indicate?
there is insufficient evidence for a difference. between the treatment and control group in the population
34
what does it mean if the confidence interval overlaps 1?
there is insufficient evidence that there is a difference between the drug and the placebo
35
what is the absolute risk difference?
the difference in risk between groups
36
what is the value of no difference?
when there is no absolute risk difference
37
what is the ‘number needed to treat’ (NNT)?
the number of patients you would need to treat to prevent one patient from developing the disease/condition/outcome
38
what is the risk ratio?
number of events of interest/ total number of observations
39
what is the odds ratio?
number of events of interest/ number without the event
40
what does a P value less than 0.05 mean?
you reject the null hypothesis your results are significantly significant
41
what is the dosage of fluoride tablets given to children?
6 months- 3 years= 0.25mg/d 3-6 years= 0.5mg/d 6+years= 1mg/d
42
what dosage of fluoride mouthwash would you prescribe to children?
225ppm age 6+ only
43
what are the symptoms of fluoride toxicty?
* nausea * abdominal pain * diarrhoea * vomiting
44
what are the general health effects of smoking?
* narrows arteries and increases atherosclerosis * increased risk of stroke * increased chest infections, COPD, bronchitis and lung cancer * increased stomach ulcers and stomach cancer * increased risk of CHD and heart attack * can cause macular degeneration and peripheral vascular disease
45
what are the oral health effects of smoking?
increased risk of oral cancer increase in periodontal disease, alveolar bone loss, attachment losss, pocket formation increased risk of dry socket after dental extractions halitosis and xerostomia staining of teeth and restorations nicotine stomatitis
46
what are recent health promotion approaches in Scotland that have reduced smoking?
* age of purchase went from 16 -18 * plain packaing onf tobacco with health warnings * packets no longer visibly on sale * no longer in vending machines * public smoking ban in 2006
47
what types of approaches can be used for smoking cessation in the dental practice?
5 As- ask, advise, assess, assist, arrange ask, advise, refer
48
what periodontal phenomenom is experienced by smokers when trying to quit?
rebound gingivitis due to increased vascularity
49
what is a null hypothesis?
general statement suggesting that there is no statistical significance in a set of data
50
how do you calculate an odds ratio?
no. time x occurred/no. times x never occurred DIVIDED BY no. times y occurred/no. times y never occurred
51
give roles of epidemiology
to assess people’s risk of disease to study the causes and determinants of disease to develop preventive programmes to evaluate interventions e.g.oral cancer screening
52
What are the forms of abuse that may be involved in domestic abuse?
Physical violence Verbal abuse Emotional abuse Sexual abuse Financial Abuse
53
What process should you follow to ask about the possibility of domestic abuse
AVDR Ask - ask about abuse in a private setting Validate - show you are concerned about them Document - be specific and detailed, use patients own words and describe injuries in as much detail as possible Refer - signpost to appropriate services
54
What are physical signs you may see in domestic abuse ?
repeated injuries Bruises at different stages if healing dental/maxillofacial injuries facial bruising, strangle marks around the neck or fingertip bruising TMJ problems -Orofacial pain
55
What questions would you ask a patient who smokes?
what do they smoke? How often do they smoke? How long have they smoked for? Have they ever tried to quit before?
56
What advice would you give to patients about vaping?
Explain there is not enough research to determine long term effects of vaping however they are considered safer than normal cigarettes recommend research backed methods to quitting smoking (e.g. nicotine patches) don’t use as an alternative to smoking - use as a method of quoting try not to use in public or infront of children
57
What are the 5 A’s in smoking sessation?
Ask - about smoking Advise Assess Assist arrange follow up for patients
58
What is the shortened approach to smoking cessation ?
Ask - establish smoking status and record Advise Act - offer referal to local stop smoking services
59
What are services to refer to for smoking cessation
local stop smoking services Local pharmacy
60
What periodontal issue might occur when patients stop smoking?
increased bleeding when brushing due to gingival blood flow increasing
61
give examples of primary study designs
randomised control trials cohort studies case-control studies
62
define dependence
a compulsive physiological and psychological need for a habit forming substance
63
what are evidenced based treatments to support quitting smoking
nicotine patches champix e cigarettes
64
what are local services that could be referred to for smoking cessation
local pharmacy specialist services
65
what do you do if a patient decides now is not the right time to quit smoking
record the advice given in the notes make a note to bring it up in the future give leaflet to patient and let them know advice is available when they want it
66
what standards were developed to improve the reporting of RCT
consort - consolidated standards of reporting trials
67
what does a confidence interval do?
tells us the range of values that a true population treatment effect is likely to lie
68
how do you reduce bias in a study design?
randomising double blinding
69
what advise do you give to a patient about e-cigarettes?
* reducing exposure to tobacco * likely to be safer but evidence base is still developing
70
how is PICO used in study design?
population intervention comparison outcome
71
define significance
a measure of the probability of the null hypothesis being true compared to the acceptable level of uncertainty regarding the true answer

Need to Know (21 decks)

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