Prevalence and Prevention in Population

Question 1

What is epidemiology?

Answer 1

the study of the distribution and determinants of diseases in populations

Question 2

What is distribution?

Answer 2

burden of the disease

Question 3

What are determinants?

Answer 3

cause or risk factors of the disease

Question 4

What is population?

Answer 4

groups of individuals geographic/ area/ community/ community of interest (ages, minorities, races)

Question 5

What are the epidemiology principles?

Answer 5

time
place
person

Question 6

What are demographics influenced by?

Answer 6

births
deaths
ages
gender
migration

Question 7

What are counts?

Answer 7

no.of people affected by a particular condition (at a particular time, and area)

Question 8

What is prevalence?

Answer 8

is the proportion (%) of population with a disease at any given point (point prevalence) or period (period prevalence in time)

i.e 10% of the population are affected

Question 9

What is incidence?

Answer 9

is the number of new cases of a disease in a defined population over a defined period of time (rate)

i.e. 10 per 100,00 per annum are affected

Question 10

What is the standardised data?

Answer 10

takes into account population age-structure

i.e. older population = more cancer

Question 11

What is the most common oral disease?

Answer 11

caries

Question 12

How are caries recorded/measured (methods)?

Answer 12

• DMF/dmfIndex
  – no. of decayed, missing, filled teeth (or surfaces DMFS/dmfs)
• ICDAS
  – International Caries Detection and Assessment System – Restorative status and Caries status scores
• Significant Caries Index
  – takes into account skewed distribution of caries in population

Question 13

What system is most effective for enamel caries?

Answer 13

ICDAS

Question 14

What are D3 classifications of decay?

Answer 14

obvious decay such as lesions into the pulp or clinicaly detectable lesions in dentine

seen by the naked eye

Question 15

What has been the main driver of improvement since the 1970s?

Answer 15

flouoride toothpaste

Question 16

What was missing from the traditional biomedical model of caries causation?

Answer 16

effect of fluoride
diet (not just “substrate”)

Question 17

What are the approaches for preventing caries in populations?

Answer 17

• High risk individual approach (clinical risk assessment)
• Targeted population approach (targeting on areas of deprivation / communities)
• Whole population approach (universal ie / eg. a founding principle of the NHS)

Question 18

What is proportionate universalism?

Answer 18

proportionate targeting = greater change in gradient > +ve health outcome

Question 19

What are the strategies for delivery of fluoride?

Answer 19

• Toothpaste
• Water fluoridation
• Community fluoride schemes
  – NICE National Institute Guidelines on oral health improvement https://www.nice.org.uk/guidance/ph55

Question 20

What are strategies for diet improvement?

Answer 20

• Links with obesity
• Actions to reduce sugar
• Local community / school
• Industry (sugar substitutes, reformulation, labelling)
• SUGAR TAX !!

Question 21

What is a common risk factor approach?

Answer 21

factors such as diet, stress, hygiene, tobacco, alcohol and physcial activity

can cause a range of diseases

i.e they are a common risk factor

Question 22

What are methods of health improvement approaches?

Answer 22

• Theory-based
• Evidence-based
• Common risk factor approach
• Community engagement
• Multi-agency working
• Proportionate universalism

Question 23

What are the evidence based clinical guidelines?

Answer 23

Importance of fluoride

Register child with a dentist as early as possible (regular
attendance)

Standard risk
* All children

Enhanced risk
* SIMD 1-3 (scottish index of multiple deprivation)
* Decay experience dmft

Question 24

What does the childsmile integrated programme consist of?

Answer 24

supervised toothbrushing (targeted school universal)

FVA in nursery and school (targeted)

practice and community (targeted universal)

Question 25

What is the upstream to downstream approach?

Answer 25

upstream (healthy public policy)

>

downstream (health education and clinical prevention)

Question 26

What did childsmile incorporate in the NHS primary care payment system 2011?

Answer 26

Ø Oral health improvement advice
- Demonstrate and observe hands-on brushing instruction
-Tailored advice on diet and nutrition
- Action plan

ØFluoride varnish [2-5 years]
- For children from 2 years, apply
varnish 2 x per year
- [additional 2 x per year in
nursery / primary schools]

Question 27

Who is involved in childsmile practice and community?

Answer 27

health visitor/ nurse
dental health support worker
primary care dental practice
non-dental local community/third sector organisations

Question 28

What are the general childsmile approaches and are they upstream, midstream or downstream?

Answer 28

influencing public health policy at national level -upstream/mid

oral health training for wider workforce- midstream

supervised tooth brushing in nursery and school - midstream

universal and targeted provision of toothbrushes and toothpaste - down/mid

targeted community based fluroide varnish programmes - mid/down

integration of oral health into targeted home visits by health workers - mid/down

signposting with community initiatives - mid/down

Question 29

What were outcomes for childsmile?

Answer 29

reduction in DMFT in children