Welcom
e Dr. Shawlin Jahan Brishti
BDS(DDC), BCS(Health)
MD(Phase-A) Dental Materials, BMU
FCPS Part-II in Orthodontics
Preventive and
Community
Dentistry
CONCEPT OF HEALTH
WHO Definition-1948
"Health is a state of complete physical, mental and social
wellbeing and not merely an absence of disease or
infirmity."
1.Biomedical Concept:
health means "absence of disease".
2.Ecological Concept:
Relation between man and his environment.
Health is equilibrium between man and his environment, and
Disease is maladjustment of man to the environment.
3.Psychosocial Concept:
health is biological as well as psychosocial phenomenon.
Psychosocial is influenced by social, psychological, cultural,
economic and political factors of the people concerned.
Holistic Concept :
Holistic concept is an integrated or multi-dimensional process. It
consider all aspects of human life.
DIMENSIONS OF HEALTH
• Physical Dimension
• Mental Dimension
• Social Dimension
• Spiritual Dimension
• Emotional Dimension
• Vocational Dimension etc.
DETERMINANTS OF HEALTH
INDICATORS OF HEALTH
Iceberg of Disease
A concept closely related to the spectrum of
disease .
According to this concept, disease in a community
may be compared with an iceberg (Fig. 1.2).
1.The tip of the iceberg represents what the
physician sees in the community, i.e. clinical
cases.
2.The vast submerged portion of the iceberg
represents the hidden mass of disease, i.e. latent,
inapparent, presymptomatic and undiagnosed
cases and carriers in the community.
3. The “water line” represents the demarcation
between apparent and inapparent disease.
Importance of Iceberg of Disease
1 In some diseases [e.g. hypertension,
diabetes, anaemia, malnutrition, mental illness],
the unknown morbidity.
2. submerged portion of the iceberg] far
exceeds the known morbidity. The hidden part
of the iceberg thus constitutes an important,
undiagnosed reservoir of infection or disease in
the community, and its detection and control is
a challenge to modern techniques in preventive
medicine.
Concept of Need
Bradshaw's Taxonomy: (1972)
• Normative needs
• Felt needs
• Expressed needs
• Comparative needs
IMMUNITY AND IMMUNIZATION (INCLUDING EPI)
Introduction to EPI:
• WHO launched EPI globally in 1974
• Introduced in Bangladesh in 1979 as a pilot program.
(Bangladesh formally adopted)
• Nationwide implementation in 1985.
IMMUNITY AND IMMUNIZATION (INCLUDING EPI)
• Aim: preventing infectious disease and Reduce child
mortality through vaccination
• Initially targeted six diseases: Tuberculosis, Poliomyelitis,
Diphtheria, pertussis, tetanus and Measles (DPT MPT)
• As per current schedule, EPI in Bangladesh protects against
12 diseases
• Pentavalent ( Diphtheria,Pertussis,Tetanus, Hepatitis B,
Haemophilus influenzae Type B)
Food and Dental Caries
Food and Dental Caries
Dental Caries:
Dental caries is a slow progressive irreversible
microbial disease of the calcified tissue of the teeth
characterized by demineralization of the inorganic
portion and destruction of the organic substance of
the tooth which often leads to cavitation.
Current concept of Caries etiology:
• Host factor( susceptible tooth
surface)
• Microorganism ( Streptococcus
mutans)
• Substrate( Sucrose)
• Appropriate time
Rampant Caries
• Acute widespread caries with early
pulpal involvement of teeth which
are usually immune to decay.
• Seen at all ages including
adolescence
• Affects primary and permanent
dentition
Rampant Caries
• Multifactorial
• Frequent snacking excessive Sticky refined carbohydrate
intake
• Genetic background
• Decreased salivary flow
• Surfaces considered immune to decay i.e.proximal surfaces of
mandibular incisors are affected.
• Rapid appearance of new lesions
• Presence of multiple pulp exposures would require pulp
therapy.
• Long term treatment may be required when permanent
dentition is involved.
Nursing Bottle Caries
Specific form of rampant cares
AGE OF OCCURANCE
• Seen in infants and toddlers
DENTITION INVOLVED
• Affects primary dentition
ETIOLOGY
• Bottle feeding before sleep:
• Pacifiers dipped in honey or sweeteners.
• Prolong breast-feeding
Specific form of rampant caries
TREATMENT
• Early stages can be managed by topical fluoride.
• Directed towards maintenance of teeth till the transition
occurs( eg pulpotomy, pulpectomy)
Parents education:
• No prolong breast feeding
• No feeding during sleeping
Topic
Prevention of Dental Caries with Fluorides
Role of fluoride in caries prevention
1.Effect on hydroxyapatite crystals
a. Decreasing enamel solubility
b. Improving its crystallinity
c. Promotes remineralization
2.Effect on bacteria
a. Inhibits bacterial enzyme system
b. Suppressing cariogenic flora
3.Effect on enamel surface:
a. desorbing protein & bacteria
b.lowering the free surface energy
4.Alteration of the tooth morphology.
Fluoride Tablets
Recommended dose: The daily recommended dose of fluoride for
child below 2 years is 0.5.mg, between 2 and 3 years is 0.5–0.7 mg
and above 3 years is 1.0–1.5 mg.
Source: Textbook of preventive and community dentistry, Joseph John
School water fluoridation
▪️Systemic administration of fluoride for school going
children who are coming from non fluoridated areas.
▪️Recommended concentration of fluoride in school
water is 4-5 ppm.
▪️School water fluoridation reduces dental caries by 40%.
Prevention and control of Periodontal
disease and Dental caries
FACTORS PREDISPOSING TO PLAQUE
ACCUMULATION
• Inadequate Oral Hygiene
• Tooth Malalignment
• Restorations
• Prosthesis
• Calculus
Prevention and control of Periodontal
disease and Dental caries
Prevention of Periodontal disease:
1. Maintaining a good oral hygiene
2. Brushing teeth twice a day with fluoride tooth
paste
3. Cleaning teeth once a day with dental floss
4. Using anti microbial mouth rinse
5. Eating a balanced diet for good general health
and limit snacks
6. Visiting to the dentist regularly
Tooth brushing methods
Bass (Sulcular) Method:
Stillman Method:
Charter Method:
This method is often recommended for individuals with sensitive
gums or exposed tooth roots.
Circular (Fones) Method:
This method is suitable for children or individuals with limited
dexterity. It involves brushing in circular motions across the tooth
surfaces, ensuring all areas are covered.
Chlorhexidine:
Chlorhexidine is the most widely employed antiseptic in dentistry,
mainly in the form of oral rinse (0.12 0.2%) or toothpaste (0.5-
1%). It is one of the most effective antiplaque and anti-gingivitis
agents
Chemistry: Chlorhexidine is a chlorophenyl bisguanide and
more commonly the gluconate salts.
Use in dentistry:
Chlorhexidine is used in the following purposes:
1. Mouth rinse:
• 0.2% chlorhexidine gluconate prevents the accumulation of
plaque and onset of gingivitis
• 0.12% chlorhexidine gluconate solution is also an antiplaque or
anti-gingivitis mouth wash,
• Twice daily chlorhexidine rinse markedly reduces oral infections
in immuno-compromised patients including those with AIDS.
2. Irrigator:
• 400 ml of a 0.02% solution of chlorhexidine (8Omg totally)
applied once daily in an oral irrigator will give complete plaque
inhibition.
Side effects of chlorhexidine
1. Taste disturbances
2. Staining
3. Desquamation and soreness of oral mucosa
Epidemiological Triad
Behavior guidance
Protective stabilization
Behavior guidance
Tell show do technique
School based preventive programmes
1. Class room Toothbrushing :
▪️Mechanical removal of plaque
▪️Toothbrushing along with fluoridated toothpaste is essential.
School based preventive programmes
2. Fluoride therapy-
i) School water fluoridation
▪️Sodium fluoride of 4-5 ppm used in drinking water
▪️Supervised fluoride tablet supplementation programme
ii. Fluoride mouth rinsing programme in school
▪️Daily mouth rinse (0.05% NaF mouth rinse)
▪️Weekly /fortnightly mouth rinse (0. .2% NaF)
▪️0.2% NaF is effective in 44-45% reduction in caries
iii. Topical fluoride therapy
▪️2% neutral NaF
School based preventive programmes
3. School based sealant, programme
▪️90% of all carious lesion occur in pits and fissure
▪️Dental assistants or hygienists can be trained for pits
and fissure sealant programme
4. School lunch programme
▪️Balanced diet
▪️School lunch box
School based preventive programmes
Who can provide health education:
1. Doctor/dentist
2. Nurse
3. Dental auxiliaries
• Dental hygienist
• School dental nurse
• Dental surgery assistant
4. Teachers
5. Parents
TOOLS OF DENTAL PUBLIC HEALTH
1. Epidemiology
2. Biostatistics
3. Social sciences
4. Principles of administrations
5. Preventive dentistry
BIOSTATISTICS: Quick bite (493page)
Types of data:
A. On the basis of source:
1. Primary data:
Primary data is that data which is obtained directly from an
individual.
2. Secondary data: Secondary data is that data which is
obtained through an outside source.
BIOSTATISTICS:
B. On the basis of nature:
1. Quantitative: Data which have a magnitude. Example- weight_of a
person
a. Continuous data: It takes the value between ranges of values, e.g.
height, weight, age etc
b. Discrete data: These are distinct and separate and also invariably
whole numbers e.g. No. of deaths due to particular disease
2. Qualitative: Data which have no magnitude or size.
Example- -male, female; vaccinated, not vaccinated; anemic, not
anemic, etc.
Measure of central tendency
Mean:
Mean indicates Arithmetic Mean which isobtained by summing
up all the observations & divides the total by the total number of
observation.
Example patients receiving treatment in the diagnosis
department of following ages 10, 12, 7,9,12, 70
The mean is = (10+12+7+9+12+70)/6 = 120/6 = 20
Measure of central tendency
Median:
Median is the value that divides a distribution into two halves
and is a better indicator of central value.
Example--numbers of children in 5 families are: 4, 2, 4, 3, 1
Arranging the observation in ascending_or descending _order
gives 1,2,3,4,4 V
Median =3
Measure of central tendency
Mode:
Mode is the value which most frequently occurs in a series of
observations.
Example values of pulse rate per minute of a group are: 71, 72,
73, 68, 71, 71
The mode or the most frequently occurring value is 71.
Measures of dispersion
The four different measures of dispersion are:
i. Range
ii. Mean deviation
iii. Standard deviation
•Most frequently used measure of deviation
iv. Co-efficient of variation
Properties of normal distribution
• It is bell shaped curye
• It is symmetrical in distribution.
• Mean, median and mode coincide.
• The tails never touch the base line theoretically
Normal distribution is arithmetically expressed as-
Variable
Is the character of a person, object or phenomenon that can
take on different values.
RESEARCH
Research is the systematic investigation into and study of
materials and sources in order to establish facts and reach new
conclusions.
Placebo:
A placebo is an agent which looks tastes and smells like
experimental drug or agent, but has no physiologic effect on the
patient.
Why placebo is used in clinical trial:
1. Evaluation of a new medicament
2. Evaluation of a preventive agent
3. Efficacy of the therapeutic activity of new product
4. To access the effectiveness and efficacy of the health service
Blinding:
Randomization cannot guard against, some sorts of bias nor the
size of the sample.
In order to reduce these problems. the technique is known as
blinding.
It can be done in three ways :
1. Single blind study: The study is so planned that the participant
is not aware whether he/she belongs to study or control group.
2. Double blind study: The study, which is so planned that neither
the doctor nor the participant is aware of the group allocation and
the treatment received
3. Triple blind study: The study is so planned that the participant,
the investigator and the person analyzing the data are all blind.
Difference between survey and research:
Research
▪️The systematic investigation into and
study of materials and sources in order to establish facts and
reach new conclusions
▪️Research is representatıve
▪️Research answers them by factorials
Survey
▪️Investigate the opinions or experience of (a group of people) by
asking them questions.
▪️Surveys are random.
▪️Surveys answer a series of questions.
Types of survey:
1. Descriptive survey: It sets out to describe a situation, e.g.
the distribution of a disease, in a population in relation to sex
and age.
2. Analytic survey: Analytic survey tries to explain the situation
i.e. to study the determinative process. This is done by
formulating and testing hypothesis
3. Cross sectional survey: A cross sectional survey provides
information about the situation that exists at a single time
4.Longitudinal survey: A longitudinal survey provides data
about events or changes during a period of time, e.g.
psychological survey.
SAMPLING PROCEDURE :
EPIDEMIOLOGY
An epidemiological study is a
type of research that
investigates the distribution,
causes, and control of
diseases or health conditions
in a population.
STUDY DESIGN
STUDY DESIGN
Important Topics
1)Caries and Flouride
2)Biostatistics
3)Epidemiological study
4)Forensic odontology
