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INTRODUCTION TO COMMUNITY DENTISTRY

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COMMUNITY/ PUBLIC/ STATE/ SOCIETY/ NATION

A body of having a common organization or living in the same place under the same laws or regulations.

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HEALTH
According to WHO, it is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

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PUBLIC HEALTH/ COMMUNITY HEALTH

The effort that is organized by society to protect, promote & restore the health & quality of life of the people.

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DENTAL PUBLIC HEALTH PRACTITIONERS

Should be knowledgeable in both oral health practice and dental public health. Are dentists or dental hygienists

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COMMUNITY DENTAL HEALTH/ PUBLIC HEALTH DENTISTRY/ COMMUNITY DENTISTRY/ DENTAL PUBLIC HEALTH
The art and science of preventing and controlling dental disease and promoting dental health through organized community efforts.

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OBJECTIVES OF DENTAL PUBLIC HEALTH:

Health policy and program management and administration, Research methods in dental public health, Oral health promotion and disease, and Oral health services delivery system.

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Principles involved in community

The patient in the community as a whole w/ varied socio-cultural influences. Attainment of goals and objectives effort and cooperation. Greatest benefit to greatest number The most efficient method of prevent does not rely on a high degree of individual.
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Dynamics of Public Health

Although dental disease is prevalent and oral health a worthy goal, not all people avail themselves of dental services. There are many barriers to dental care, some relate to education, some to finances, some to cultural habits, and some to the dental care.

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Social Aspect
Dental care delivery system are also affected such as whether a country as at war. Dental health care professional need to be aware of current and changing conditions that may affect dental care delivery systems throughout the world. Planning, implementing, and evaluating any dental health care delivery System require a multidisciplinary approach including the behavioral, political, and social sciences, as well as the dental sciences.
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2. ECONOMIC CONCEPT
It describes the methods of payment for dental care. One such development is the change of payment from a purely private out-ofpocket transaction between dentist and patient into a layered group financing of dental care.

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HISTORY OF PUBLIC HEALTH

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 Historical perspective with the 19th century came two dramatic advances in the effectiveness of public health the great sanitary awakening (Winslow, quoted in The Future of Public Health) and the advent of bacteriology and the germ theory. Those of us who see all progress in the field of health in terms of laboratory discoveries and the medicines have not had the experience of living in a 19th century city.

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 In New York City, piles of garbage twothree feet high were accompanied by epidemic smallpox and typhus. The crowding, poverty, filth, and lack of basic sanitation in the working class districts of the growing cities provided efficient breeding grounds for communicable diseases.

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 Quarantine and isolation, which were somewhat effective against individual cases and illness brought by travelers, were inadequate against mass endemic disease. Moreover, industrialization and urbanization closer. No longer able to escape to their country estates, well-to-do families also fell prey to the highly contagious diseases incubated among the working class.

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 In England, the Poor Law Commission led by Edwin Chadwick studied the English health of the working class. Their famous and controversial General Report on the Sanitary Conditions of the Labouring Population of Great Britain presented a damning and fully documented indictment of the appalling conditions (Chave, in FPH). The studies revealed that the average age at death for laborers was 16 years. For tradesmen it was 22 years; for the gentry, 36 years.
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GREAT PEOPLE IN HISTORY OF PUBLIC HEALTH:

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 1334 Petrarch introduces the concept of comparison and indeed of a clinical trial.

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 1603 John Graunt Bills of mortality and the law of mortality. The first life table, giving the probability of dying at each age.

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 1700 Bernadio Ramazzini Father of Occupational epidemiology; also breast cancer in-nuns.

1706 1777 Francois Bossier, de Lacroix (known as Sauvages) systematic classification of diseases (Nosologia Methodica)
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 1798 Edward Jenner cowpox vaccination against smallpox

1787-1872 Pierre Charles Alexandre Louis the Father of Epidemiology, La methodenumerique LaPlace, Poisson the birth of statistics.
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 1847 Ignaz Semmelwies (Vienna) discovers transmission and prevention of puerperal fever

1914-1918 Joseph Goldberg studies pellagra.

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MEASUREMENTS OF THE LEVEL OF HEALTH

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I. THE MEASUREMENT OF DEATH

Deaths are classified using a standard coding system called the ICD (International Classification of Deaths), which has been organized and published by the World Health Organization since 1946. In theory, the ICD is a very useful tool in the analysis of trends and differentials in cause of death and in the assessment of progress in overcoming life-threatening diseases and conditions. In practice, however, the ICD contains a number of limitations.
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 First

cross-national comparisons are affected by variations in data quality. These variations result from differences in the diagnostic skill and type of training of the certifying medical attendant or coroner, in the accuracy of the diagnosis recorded on the death certificate.

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 A second limitation is that ICD categories are

based on single cause of death. This is the underlying cause that is deemed by the medical examiner to have generated the sequelae leading to death. For populations in developed countries, in which multiple causes are often involved, a classification system based on a single cause of death can result in a distorted picture of mortality causation.

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 Third trend analysis can be affected by changes over time in the ICD categories themselves. An apparent increase or decrease in a cause of death may be the result of coding/ classification change only. While changing categorization and transformation in disease patterns, a downside is that some distorted trends may emerge. Thus, any analyst of cause of death trends must be aware of ICD changes that could lead to findings that are merely 28 artifacts of reclassification. SOTOUDEH.MARYAM

II. Measurement of Morbidity

Morbidity The condition of being diseased. Proportional morbidity The proportion of all of the diseased animals in the population that have the particular disease under discussion.

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MORBIDITY RATE
The ratio of diseased to healthy animals in the population. The ratio is said to be standardized when it is expressed as a proportion of the expected rate compared with standard group. It is also expressed as a proportionate rate when it is stated as a proportion of all of the cases of illness due to all causes in the group. Factors: health, vital statistics, duration.
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ETIOLOGICAL FACTORS OF DISEASES

One of the most common bases for classifying diseases is according to cause. External factors that produce diseases are infectious agents, including both microscopic organisms, characterized by the lack of a membrane-bound nucleus and membrane bound organelles.

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VIRUS
Parasite with a noncellular structure composed mainly of nucleic acid within a protein coot. Viruses usually are too-small (100-2,000 Angstrom Units) to be seen with the light microscope and thus must be studied by electron microscopes.

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PROTOZOAN
informal term for the unicellular heterotrophs of the kingdom Protista.

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FUNGI
kingdom of heterotrophic single-celled multinucleated or multi-cellular organisms, including yeasts, molds.

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WORM
Common name for various unrelated invertebrate animals with soft often long and slender bodies. Members of the phylum Platyhelminthes or the flatworms are the most primitive; they are generally small and flat-bodied and include the free-living planarians.

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COMMUNICABLE DISEASES
illnesses caused by microorganisms and transmitted from an infected person or animal to another person or animal. Some diseases are passed on by direct or indirect contact with infected persons or with their excretions.

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 Other external agents that can cause disease are chemical and physical agents (drugs, poisons, radiation) which can be encountered in specific work situation, deficiency of nutrients in the environment, and physical injury.

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CHARACTERISTICS OF PUBLIC HEALTH

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CHARACTERISTICS OF PUBLIC HEALTH

Group responsibility - Maintaining health through isolation and quarantine.

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Rural Health Unit consists of:

Rural health Doctors Rural health Dentist Rural health Nurse Rural health Midwife Sanitarians

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 Teamwork - Physicians and sanitarians should work together to cope up with the needs of the community. Prevention - Institution of preventive measures and programs.

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ROLE OF THE PRIVATE PRACTITIONER IN PUBLIC HEALTH COMMUNITY DENTISTRY

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 An adviser on community affairs resides in the practicing dentist whether he wills it or not.

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 An active participant in community affairs which will be determined by the manner in which the dentists opportunities are accepted and handled.

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SCOPE OF PUBLIC HEALTH

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1. Those fields in which activity must be on community bases a. Supervision of food, water and milk supplies of a community. b. Insect control and vermin control. c. Prevention of atmospheric and stream pollution.

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e. Certain mental, personality and behavioural disorders. f. Occupational health g. Cancer (limitation of progression : prevention to extent possible)

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2. Those fields which deal with presentable illness, disability or premature death. a.Communicable disease including infection. b.Dietary deficiency c.Effects of addicting drugs and narcotics d.Allergic manifestations and their community sources
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DENTAL DISEASES
TWO DENTAL DISEASES OF THE MOUTH: 1. PERIODONTAL DISEASE - the primary cause of patient's losing teeth.

2. DENTAL CARIES - the second most common reason for patient's losing teeth.
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IMPORTANT CHARACTERISTICS OF THE TWO DENTAL DISEASES OF THE MOUTH:

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1. They are of almost universal prevalence. PREVALENCE - is the proportion of a population affected with a disease at a given point in time.
2. They do not undergo remission or termination if left untreated, as do many diseases that accumulate a backlog of unmet needs.

3. They normally or usually require technically demanding, expensive and timeconsuming professional treatment.
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THEORIES IN THE CAUSATION OF DENTAL CARIES:

1. ACIDOGENIC THEORY 2. PROTEOLYSIS THEORY 3. MICROSCOPIC SECRETIONS/ METABOLIC PRODUCTS OF MICROORGANISMS

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1. ACIDOGENIC THEORY ACIDOGENIC - particular foods have the ability to reduce the pH of plaque when consumed and are considered to be acidogenic. The reduction in pH is considered a necessary condition for the development of caries. In this theory, dental decay is caused by acids produced by microbial enzymatic action on ingested carbohydrates. These acids will decalcify the inorganic portion of the teeth, then the organic portion is disintegrated, creating cavities.
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2. PROTEOLYSIS THEORY This theory claims that the organic portion of the tooth is attacked first with certain lytic enzymes. This leaves the inorganic portion without a matrix support, causing it to be washed away, creating cavities. 3. MICROSCOPIC SECRETIONS/ METABOLIC PRODUCTS OF MICROORGANISMS This theory have the ability to chelate calcium from tooth substances, leaving the organic matrix to be disintegrated.SOTOUDEH.MARYAM 54

THREE ETIOLOGIC FACTORS THAT PLAY A SPECIFIC ROLE IN THE CAUSATION OF DENTAL CARIES:
1. HOST (Tooth) 2. AGENT ( Bacteria/ Plaque microorganisms) 3. ENVIRONMENT ( Carbohydrates in the diet)

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I. HOST
The tooth is the primary host factor, but its composition, morphological characteristics and locations influence the caries process.

1.Composition Caries susceptibility of a tooth is inversely proportional to its fluorine, calcium and tin contents.

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2.Morphological characteristics Accdg. To G.V Black, the ff. areas on the tooth surface are relatively non-selfcleansable.
Pits and fissures Contact areas Area of near approach Gingival embrasures Facial or lingual surfaces apical; to the cervical ridge
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Areas on tooth are relatively cleansable:

Tip of cusps Crests of marginal and crossing ridges All inclined planes of cusps ang ridges Occlusal, incisal, facial, abd lingual embrasurs Facial or lingual surfaces, incisal or occlusal to the height of contour with the exception of pits Axial angles of teeth

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3. Location a. The closer the posterior teeth are to the ramus, the greater is the probability of food accumulation. b. Malaligned teeth, causing improper contacts.

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Saliva is the second major factor. Salivary factors involved are:

1. Composition Caries susceptibility is inversely proportional to salivary phosphate content. Higher organic content in the saliva generally indicates more stable plaque formation. 2. pH Higher alkaline saliva predisposes to less decay activity.
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3. Viscosity Serious saliva (low viscosity) predisposes to more self-cleansability than mucinous (high viscosity) saliva. 4. Flow Higher quantities of saliva flowing in the oral cavity predisposes to less decay activity. 5. Antibacterial elements Found in the saliva but, their anticariogenecity depends on their nature, SOTOUDEH.MARYAM concentration and amounts. 61

6. Antibody elements Immunological activities have been identified in the saliva.

II. AGENT

Streptococcus mutans play a major role in the adhesion (production of dextrane) necessary for tooth cavitation.

III. ENVIRONMENT

Physical and chemical characteristics of a diet determine its relative cariogenecity.

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Physical characteristics: Harder and more fibrous food material necessitates increased masticatory activity and greater ability for cleaning the teeth surfaces of any stagnating debris. Chemical characteristics: Carbohydrates are known to be the most cariogenic of all food materials. Sucrose is the most detrimental, followed by fructose, lactose, galactose and glucose.
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Increase fluoride content in the diet - decrease caries activity - decrease the solubility of tooth structure - decrease the surface energy of tooth surfaces - discouraging plaque adhesion

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THE END THANK YOU!!!

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