Dental public health

Even with fluoridation and oral hygiene, tooth decay is still the most common diet–related disease affecting many people. Tooth decay has the economic impact of heart disease, obesity and diabetes. Risk factors for tooth decay include physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. Cavities can develop on any surface of a tooth, but are most common inside the pits and fissures in grooves on chewing surfaces. The cause of tooth decay is the acid produced by bacteria that dissolves the hard tissues of the tooth (enamel, dentin, and cementum). The acid is produced by bacteria when they break down food residue or sugar on the tooth surface. This is where the toothbrush bristles and fluoride toothpaste cannot reach effectively. One of the first signs of caries may be persistent tooth sensitivity. If a tooth reacts to hot, cold, or sweet foods and the sensation persists, this may indicate weakened enamel. Gum diseases gingivitis and periodontitis are caused by certain types of bacteria that accumulate in remaining dental plaque. The extent of gum disease depends on host susceptibility. Daily brushing must include brushing of both the teeth and gums. Effective brushing itself, will prevent progression of both tooth decay and gum diseases. Neutralising acids after eating and at least twice a day brushing with fluoridated toothpaste will assist preventing dental decay. Stimulating saliva flow assists in the remineralisation process of teeth, this can be done by chewing sugar free gum. Sometimes complete removal of dental plaque is difficult, and the help of a dentist or hygienist may be required. Fissure sealants applied over the chewing surfaces of teeth, block plaque from being trapped inside pits and fissures. The sealants make brushing more effective and prevent acid demineralisation and tooth decay. A diet low in fermentable carbohydrates will reduce the buildup of plaque on teeth. == Practice ==

Competencies The American Board of Dental Public Health devised a list of competencies for dental public health specialists to follow. Dental public health specialists are a select group of certified dentists. The ten competencies allow for growth and learning of individuals and set expectations for the future. An advantage of the design is that they are implementable on a global level. The list is updated periodically. • Oral health surveillance National Oral Health Surveillance system (NOHSS) is designed to monitor the effects of oral disease on the population, as well as monitor how the oral care is delivered. Additionally, the status of water fluoridation on both a state and a national level is continually supervised. • Assessing the evidence on oral health and dental interventions, programmes, and services • Policy and strategy development and implementation • Oral health improvement • Health and public protection • Developing and monitoring quality dental services • Dental public health intelligence • Academic dental public health • Role within health services ==Principles and criteria==

Dental health is concerned with promoting health of an entire population and focuses on an action at a community level, rather than at an individual clinical approach. Dental public health is a broad subject that seeks to expand the range of factors that influences peoples oral health and the most effective means of preventing and treating these oral health problems. To allow a health problem to be properly managed, a set of rules or criteria may determine what is defined as a public health problem and what is the best way to manage health problems in communities. Once these questions have been answered, the way a public health problem is acted upon to protect a population can be determined. ==Approaches to prevention==

Fluoridation of drinking water Water fluoridation is the implementation of artificial fluoride in public water supplies with the intentions to halt the progression of dental diseases. Fluoride has the ability to interfere with the demineralisation and remineralisation process that occurs on the tooth surface and improves the mineral intake when the pH level may reduce below the neutral pH level. This achievement was implemented through the public health development in the 19th, 20th century and led into the 21st century. Research into the effects of fluoride on teeth began due to the concern about the presence of dental fluorosis. Many clinical case trials occurred in the beginning of the 20th century. However, the very first clinical trial to have occurred dates back to the 19th century when Denninger conducted a trial prescribing children and pregnant women with calcium fluoride. The development of artificial water fluoridation began in 1945 in Grand Rapids, Michigan followed by Newburgh, New York and Evanston, Illinois. In 1955, three towns Watford, Kilmarnock and Anglesey trialled the water fluoridation implementation scheme. This education can be focused towards dental practitioners and to the wider population who may interested. There has been a change in focus in the education of developing clinicians all over the world. The first dental school was developed in 1828 and was followed by an ever-growing field of practice. The dental practice began with its main focus on the treatment of oral disease and branched into a wide scope of practice with many dental occupations involved. The most common form of dental clinicians are either general dentists, oral health therapists, dental therapists and dental hygienist. When desired, some of these clinicians may seek further experience in projects that may assist the dental public system in bringing further awareness to prevention of dental diseases. Oral health prevention is the current form of practice of many clinicians. Health professionals generally prefer education in oral care to the population to the treatment of the disease. Dental university education develops clinicians to focus on the education of patients, education of the community and a wider population using different approaches. ==Approaches to promotion==

Oral health promotion outlines the strategies for improving and educating the general public about how they can better take improve and maintain their current oral health. Oral health promotion is part of both government and private incentives to create a healthier and better educated generation of individuals. Below are the nine key principles involved for oral health promotion: Three ways to achieve oral health promotion include addressing the determinants of oral health, ensuring community participation, and implementing a strategy approach that involves a range of complementary actions. These factors are also influenced by sociopolitical considerations that are outside the control of most individuals. Community participation is a key factor in oral health promotion. Inter-sectoral collaboration is where relevant agencies and sectors are involved in partnership to identify key oral health issues and to implement new methods to improve oral health. The World Health Organization has agreed on a health promotion approach as the foundation for oral health improvement strategies and policies for the population. Oral health promotion is based on the principles of the framework, Ottawa Charter. There are five areas of action outlined to achieve oral health promotion; building Health public policy, creating supportive environment, strengthening community action, developing personal skills, re-orienting healthcare services. == Research ==

Oral health in care homes A study investigating the efficacy of staff workers' oral care education on improving the oral health of care home residents found that despite the education and training of care workers, certain ongoing barriers prevented them from conducting the necessary daily oral hygiene care for the residents. The most frequently listed obstacles to care included the residents' bad breath, inadequate time to perform oral care and uncooperative residents who do not perceive the need for oral care. Another study on the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health for nursing home residents shows insufficient supporting evidence. School dental screening programs It is unclear whether or not school screening programs improve attendance at the dentist. There is low-certainty evidence that school screening initiatives with incentives attached, such as free treatment, may be helpful in improving oral health of children. One-to-one oral hygiene advice provided in a dental setting for oral health One-to-one oral hygiene advice (OHA) is often given on a regular basis to motivate individuals and to improve one's oral health. However, it is still unclear if one-to-one OHA in a dental settings is effective in improving one's oral health. Regardless of the increased oral hygiene education programs in schools due to the higher quality of life, there is an increased intake of processed food, especially of sweetened beverages. The favorable effect of the increased level of dental health education may be counteracted by nutritional behavior, especially sweets intake and low attendance of regular dental office check-ups and insufficient oral health practices (tooth brushing) generating a still increased caries prevalence and DMFT index in adolescents. Irregular dental check-up and sugary dietary habits were associated with high prevalence the occurrence of dental conditions as assessed by the decayed, missing (due to caries), and filled teeth (DMFT) index. Community-based population level interventions for promoting child oral health A systematic review sought to determine the effectiveness of different interventions in preventing dental caries in children and when was the most effective time to intervene during childhood. Overall, the evidence showed low certainty that combining oral health education alongside supervised tooth-brushing or professional intervention would reduce dental caries in children (from birth to 18). The most effective time to intervene in childhood was still unclear as well. Improving the diets of children and the access to fluoride showed only a limited impact to improving the oral health of children. == Examples ==

Australia Child Dental Benefits Schedule (CDBS) • A Government funded program which provides assistance for basic dental services for children aged 2–17 years. Services provided include: examinations, dental x-rays, cleaning, fissure sealants, fillings, extractions and root canals • The CDBS is means tested, those who qualify are eligible to $1,000 of the aforementioned treatments over a two-year period. To find out if a child is eligible, families can contact the Department of Human Services • Availability of treatment All treatment deemed necessary to maintain optimal oral health will be provided by the dentist, however not all treatments will be funded by the Dentistry NHS and will incur private fees. In Nepal, implementing health insurance is difficult due to limited supply of finances. To assist families with accessing health care "elimination of direct payments is necessary but is not sufficient alone; costs of transportation and loss of income can have more impact than direct payment of services" must be considered. • Nepal is now using dental hygienists, therapists and oral health therapists to increase access to dental treatment. • Programs such as training rural women about oral health promotion are being utilized to increase awareness of basic dental problems in remote areas. Dental outreach program • Attempts to reduce the gap in dental health of Nepalese people through volunteer work provides oral health care education and basic treatment to small villages. • Services provided include oral hygiene instruction, distribution of free toothbrush and fluoride toothpaste, application of fluoride gel, application of sealant, screening and charting out treatment plan under a supervising dentist, scaling, filling, extraction, prescribing medicine, and free dispensing distributing medicines For more information, you can access the Around Good People fact sheet ==Early history==

The earliest known person identified as a dental practitioner dates back to 2600BC, an Egyptian scribe states that he was 'the greatest of those who deal with teeth ad of physicians' • 1500BC- Egyptian Ebers papyrus explains oral disease and offers prescription for strengthening teeth and gums • 9th century AD- The Arabs discussed the care of teeth rather than extractions and replacement. Mouth hygiene was established with a small wooden stick • Late 1400s- The first tooth brush was invented by the Chinese • 1723- A French surgeon describes a comprehensive care system for dentistry including restorative techniques and denture reconstruction • 1791- The first dental treatment available for the poor, established in New York City • 1840- The world's first national dental organisation was founded • 1861- Philadelphian charity hospital offers dental services • 1865- First ever children's dental clinic, established in Germany • 1867- Boston opened its first low income dental clinic • 1884- The term Oral Hygiene come about when ML Rhein asks dentists to teach patients how to brush their teeth • 1890- A committee in England carried out oral hygiene promotion in schools • 1896- The powerful slogan 'A clean tooth never decays' helps improves standards of mouth hygiene • 1931- Fluoride is identified • 1944- UK Education Act 1944 made it compulsory for children at primary and secondary schools to have dental inspections leading to the provision of a School Dental Service • 1945- First ever water fluoridation • 1969- World Health Organization (WHO) establishes a data bank which collect information on dental health and needs • 1996- WHO Oral Health Country/Area Profile Program (CAPP) is established, this online database presents information on individual countries oral health services and oral disease rates == See also ==