An ounce of prevention is worth a pound of dental care

-old Dental Public Health Proverb

Prevention of premature death, disease, disability, and suffering should be a primary goal of any society to provide a decent future and a better quality life for its people. Primary prevention Secondary prevention Tertiary prevention

Effective: having an effect: producing a result Community: all people living in a particular district, city, etc Prevention: to keep from happening: make impossible by prior action; hinder Program: a plan or procedure for dealing with some matter

In essence an effective community prevention program is a planned procedure that prevents the onset of a disease among a group of individuals.

Dental caries, or tooth decay, is both a universal and a lifelong disease All of us are at risk for caries as we have our natural teeth It is important to prevent the onset of the disease because once the tooth is restored, the restoration must be replaced over time and each restoration becomes larger and larger

As part of our role as health professionals, we are called on to assist health agencies and organizations in developing plans for obtaining dental care We need to develop our own abilities to take our dental expertise and channel it into the areas of policy development, decision making, and program planning

Comparison of the provision of the Dental care for a Private patient and a Community

The dentist conducts a dental and medical history and a clinical examination for the patient The dentist diagnoses the oral health of the patient The dentist develops a treatment plan based on the diagnosis, the priorities, the patients attitude, and the method of payment for the service The dentist obtains patient consent for treatment The dentist selects the appropriate dental services for the patient: preventive services, restorative services, endodontic services, and so on The dentist evaluates the treatment rendered to the patient: clinical examination, radiographs, patient oral hygiene, patient satisfaction

The planner conducts a survey of the communitys structure and dental status The planner analyzes the survey data of the community The planner develops a program based on the analysis of the survey data, the priorities and alternatives, the communitys attitudes, and the recourses available The planner obtains community approval of the plan The planner selects the appropriate labor to implement the program: dentist, dental hygienist, dental assistant, dental technician, nutritionist, health educator, schoolteacher, social worker, health aides, public health nurses

The planner selects the appropriate activities for the community: community water fluoridation, school- based fluoride rinse programs, comprehensive dental services, oral cancer screening and referral programs The planner evaluates the community program: comparison of baseline survey, attainment of goals and objective, costeffectiveness of activities, appropriateness of activities, community satisfaction

E. E. Banfield presents a basic definition of the term planning: a plan is a decision about a coarse of action. In other words, a plan is a systematic approach to defining the problem, setting priorities, developing specific goals and objectives, and determining alternative strategies and methods of implementation.

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Problem solving planning involves the identification and resolution of a problem Program planning entails designing a course of action for a circumscribed health problem Coordination of efforts and activity planning aims to increase the availability, efficiency, productivity, effectiveness, and other aspects of activities and programs Planning for the allocation of resources involves selecting the best alternative to achieve a desired goal when the amount of resources is limited Creation of a plan involves the development of a blueprint or proposal of action containing recommendations and supporting data Design of standard operating procedures requires planners to come forth with a set of standards of practice or criteria for operation and evaluation

Reasons why a planner should conduct a needs assessment: 1. To define the problem and to identify its extent and severity 2. To obtain a profile of the community to ascertain the causes of the problem 3. To evaluate the effectiveness of the program

Whether the planner conducts his own survey, combines efforts with others, or uses information from past surveys, it is important to consider what type of information is needed and how it should be obtained Data can be obtained by various methods such as survey questionnaires or clinical examinations or more informally through personal communications

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The technique that the planner chooses is based on who is to be examined Factors the planner should consider are: The number of individuals involved The extend and degree of severity of the problem The attitudes of the individuals to be suveyed

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Number of individuals in the population Geographic distribution of the population Rate of growth Population density and degree of urbanization Ethnic backgrounds Diet and nutritional levels Standard of living, including types of housing Amount and type of public services and utilities Public and private school system General health profile Patterns and distribution of dental disease

After assessing the incidence and distribution of the dental disease, the planner needs to inquire into the history and current status of dental programs in the community. For that the following questions should be asked:
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What are the types of programs currently existing? Are these programs oriented toward prevention, treatment, education, research, or a combination? Who or what organization is responsible for the planning, implementation, and/ or administration of the program(s)? How successful have those responsible been? What was the communitys acceptance of such a program?

The planner must learn the way in which policies are developed and decisions are made within the community.
The following areas need to be explored: 1. Who are the financial leaders (bankers, business people), and who are the political leaders ? 2. Who sets the policies for the community? 3. What is the organizational structure of the community 4. What are the community leaders attitude toward oral health and community dental programs?

After learning how the community operates, the planner needs to examine the types of resources available to the community to implement a program These include the funds, the facilities, and the labor

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What is the source of funding at the state and local level of dental care? Is third party coverage available to the community through the workplace? Is federal funding available through special eligible programs? Are private funds available through foundations or endowments?

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7. 8. 9.

Where is the closest major medical center? What specialty services does this center provide? What dental facilities exist, and where are the located (in public schools, health centers, hospitals) How well are the facilities used by the population? Are the facilities easily accessible to the population served? Does the facility meet the required Occupational, Safety, and Health Administration (OSHA) standards for blood borne pathogens? Is the equipment adequate and running efficiently? How many operatories are available? How many dental laboratories are available?

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How many active licensed dentists, hygienists, and assistants are available? How many laboratory technicians are available? How many dental and dental auxiliary schools are located near by? How many active community health aides are available? How many public health nurses are available? How many school nurses are available? How many public health hygienists, voluntary health agencies, and nutritionists are available?

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When planning a preventive dental program for a community, it is important for the planner to determine where the population obtains water and the fluoride status of that water Many persons obtain their water from either individual wells or near by rivers, lakes or streams The amount of fluoride in the water sources might indicate to the planner that a fluoride supplement program may not be necessary

If a community is obtaining water from a certain area, the planner needs the following information: 1. What type of drinking water is available to the community? 2. What is the fluoride content of the water? 3. Does the water contain optimum levels of fluoride? 4. What efforts, if any, have been made in the past to provide fluoridation? 5. What are the attitudes of the community, the dental profession, and decision makers toward fluoridation? 6. What are the laws with regard to fluoridation? 7. Is a referendum possible or required? 8. Are the schools water supplies fluoridated?

To prevent duplication of fluoride administration, the planner also should inquire into the type of fluoride being administered to individuals in private offices, the schools, and the health centers.
1. 2. 3. 4. 5. 6.

Do local dentists or physicians prescribe fluoride supplements to their patients? Do schools (preschool, parochial, public) have a fluoride tablet or rinse program? Do the health centers or hospitals administer fluoride to their patients? Do fluoride brush in programs exist in the schools? If so, how often do children brush with a fluoride tooth paste? How successful have these programs been, and how are they supported?

Sources of information: A. Local state, federal agencies and private organizations B. Local health departments C. Chamber of commerce and town hall D. State health department E. Federal government- the National Health Surveys and the U.S. Census Bureau F. Research studies and investigative reports G. MEDLINE

The number of dentists and dental auxiliaries, as well as of facilities and operatories necessary to treat the population, is determined by obtaining the total number of service minutes requires for a given population.

Priority determination is a method of imposing peoples values and judgments of what is important onto the raw data. The method can be used for: 1. Setting priorities among problems elicited through a needs assessment 2. Ranking the solutions to the problem

If priorities are not determined, the program may not serve those individuals or groups who need the care most Certain factors should be considered in determining priorities If the health problem is dental disease, generally more than one population is affected

The following are groups commonly associated with high risk dental needs:
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4. 5.

Preschool and school aged children Mentally and/ or physically disabled persons Chronically ill and/ or medically compromised persons Expected mothers Low income minority groups (urban and rural)

Program goals are broad statements on the over all purpose of a program to meet a defined problem Program objectives are more specific and describe in a measurable way the desired and result of program activities

The program objectives should specify the following?

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What: the nature of the situation or condition to be attained Extent: the scope and magnitude of the situation or condition to be attained Who: the particular group or portion of the environment in which attainment is desired Where: the geographic areas of the program When: the time at or by which the desired situation or condition is intended to exist

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Once the problem has been identified and program goals and objectives have been established describing a solution to or a reduction of the problem, the next step is to state how to bring about the desired results Activities include three components: What is going to be done Who will be doing it When will it be done

Selection of resources for an activity, such as personnel, equipment and supplies, facilities, and financial resources, must be determined by consideration of what would be most effective, adequate, efficient, and appropriate for the tasks to be accomplished.

Some criteria that are commonly used to determine what resources should be used follow:
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Appropriateness: the most suitable resources to get the job done Adequacy: the extent or degree to which the resources would complete the job Effectiveness: how capable the resources are at completing the job Efficiency: the dollar cost and the amount of time expended to complete the job

Resource Identification Worksheet Resource

Personnel Sponsors or supporters
Public health organizations, professional dental organizations, dental and dental hygiene schools, industry, health consumer groups, government, labor, media, business, foundations, public schools Dentists, dental hygienists, dental assistants, dental technicians, social workers, health aids, public health nurses, physicians assistants, nutritionists

Source

Clinical providers Nonclinical providers

Planning Clerical Educational Analytical

Health planning agencies Volunteers, students, parents, retirees Professional organizations, universities, students Universities, consulting firms
Dental supply companies, dental and dental hygiene schools, renovated public health clinics, hospitals, federal government depositories Business, industry, civic groups, hospitals Consumer groups, industry, business, government Dental supply companies, dental products companies ADA, other professional organizations, public health agencies, diary councils, local, state, or federal agencies, i.e., National Institute for Dental Research, Centers for Disease Control Hospitals, health centers, nursing homes, public schools, dental schools, public health clinics, industry, health maintenance organizations

Equipment Dental units and instruments Computers, calculators, filling cabinets Supplies Office supplies Dental supplies Dental Health Education Materials Facilities

When planning any program, there are usually as many reasons not to do something as there are reasons to do it Constraints may result from organizational policies, resource limitations, or characteristics of the community

Being aware of the existing constraints and given the available resources, the planner should consider alternative courses of action It is important to generate a sufficient number of alternatives The planner must be aware of those alternatives that sound good on the surface but might have certain limitations when closely examined The planner needs to consider the anticipated costs and the effectiveness of each alternative

The process of putting the plan into operation is referred to as the implementation phase This phase is ongoing on situations where close supervision and evaluation of the program will ensure effective operations The implementation process involves individuals, organizations, and the community Only through teamwork between the individual and the environment can the implementation be successful

An implementation strategy for each activity is complete when the following questions have been answered: 1. Why: the effect of the objective to be achieved 2. What: the activities required to achieve the objective 3. Who: individuals responsible for each activity 4. When: chronologic sequence of activities 5. How: materials, media, methods and techniques to be used 6. How much: a cost estimate of materials and time

After the program has been implemented, it requires continuous surveillance of all activities The programs success is determined by monitoring how well the program is meeting its states objectives, how well individuals are doing their jobs, how well equipment functions, and how appropriate and adequate facilities are

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Evaluation, both informal and formal, is a necessary and important aspect of the program Evaluation allows us to: Measure the progress of each activity Measure the effectiveness of each activity Identify problems in carrying out activities Plan revision and modification Justify the dollar cost of administering the program and, if necessary, justify seeking additional funds

Each objective should be examined periodically to determine how well it is meeting the program goals Evaluation should also address the quality of what is being done The attitudes of the recipients of the program should be examined to determine whether the program was acceptable to them

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Health professionals must be prepared to meet the challenges of the coming years through the development of good planning skills These skills are: The construction of well planned and accessible health facilities The selection of appropriate, well qualified, and sensitive health personnel The provision of appropriate and effective health services The time and the fund to provide the needed care The active participation of representatives of those communities, organizations, and individuals who will be the recipients of the health care