ASSESSMENT INFORMATION

Written exam (2h) June 70%

Dental Health Month Participation 15%
o Poster presentation regarding aspect of childrens dentistry
Special Needs Dentistry Assignment 10%
o Chose a disability, 5min assignment to present the medical considerations and dental
considerations of the disability
Special Needs and Community Dentistry Report 5%
o Email Dr D-E two paragraphs; one on experience at the showground (thoughts, liked,
didnt like, good, bad change etc), two what we thought about guest lecturer and what
she said
***Lawrence Green author of many health promotion reference material***

1. PREVENTION AND HEALTH PROMOTION

1. Define Health and describe its parameters
Health is not just absence of disease it is a combination of things
Greenburg definition of health quality of life, with social, mental, emotional, spiritual, and
physical function
It is also wellness, positive state
Physical function arthritis (cant hold brush), wheelchair (limiting access)
Can have emotional or mental problems due to a physical disability
2. Define Health promotion and discuss its relevance to the community
HP - any combination of educational, organisational, economic and environmental supports
(conditions) for behaviour conducive to health
o Behaviour conducive to health hope to change behaviour to a healthier behaviour
o Environmental ie, billboards, advertising on the side of buses
Can be individual or community based
Involves individuals, society, social scientists, epidemiologists, other health professionals,
communication and marketing specialists, politicians, media, political activists
o Epidemiologists gather information about the target audience
o Communication specialists determine appropriate language
o Marketing chosing right colours and pictures for greatest effectiveness
o Get input from all these different people and modify the idea until get it right
Cultural values, attitudes and beliefs strongly influence health promotion
o Eg blood transfusions certain religions dont believe in them, therefore wouldnt
promote blood transfusions to these religious groups
o Need to think about these things when promoting health
An educational approach to health promotion is the essential starting point
Tailor the HP to the target audience sugar bugs vs strep mutans
The greater a persons educational level access to information better educated people
tend to live a healthier lifestyle whereas less educated people in general tend to live less
healthy
o Will have to start with the basics for these people without embarrassing them
o First teach them how to brush, then how to brush well, then how to flow
o Do not overload them
o People that arent informed about brushing their teeth/the need to go to the dentist
(ie, less educated) are less likely to do these things = less healthy
3. Discuss the term health education as it relates to health promotion
2

HE - any combination of learning opportunities designed to facilitate voluntary adaptations
of behaviour that are conducive to health.
o Voluntary because can explain the importance of flossing but its up to the pt to do it
HE is related to HP, it is an important part of HE
HP is always HP but HP is not always HE
o Govt placing taxes on alcohol aimed to reduce drinking (HP) without an explanation
as to why it was important (HE)
HP is the overall picture, HE is a component of it
The promotion of self cure is one of the major goals of HE
o Giving up smoking emphasise at each appointment to stop and WHY it is beneficial
to health, show them pictures of oral cancers rather than lung cancers
o Smokers aware about lung cancer but not of effect of smoking on oral cancers
o Explain dental aspects staining, halitosis, periodontal problems
4. Discuss health promotion in general terms, relating this to the community
Community based health programs
Usually look at and target the most common diseases and their risk factors (smoking,
alcohol, high cholesterol, diet etc) aim programs around these diseases
Involve three things
o Extensive use of epidemiological data in the planning
E.g seatbelts- used a lot of statistic for large community based
o Educational and intervention activities based on currently accepted theories of
health behaviour
Pictures of oral cancer etc on cigarette packets, breast screening
o Clearly specific hypotheses that are tested to evaluate the success of the project
World Health Organization
1982 Global Goals for Oral Health for the year 2000, Established by the Federaiton Dentaire
Internationale and the WHO
50% of 5 yo 6 years old will be caries free
The global average will be no more than 3 DMF teeth at age 12
85% of the population should retian all their permanent teeth at age 18
A 50% reduction in present leves of edentulousness at age 35 to 40 will be achieved
A 25% reduction in present levels of edenulousness at age 65 and over will be achieved
A database will be established for monitoring change in oral
5. Draw and explain the planning cycle when setting up a health promotion program
HP follows a planning cycle or a path /steps that you follow to achieve your goals
This is only one example of a planning cycle there are many available

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EXAMPLE getting seat belts in the car
o Cars first invented with no seatbelts = crashes and deaths
o Idea was formed to this by use of seatbelts
o Data was collected how many car accidents? How many mortalities?
o LT goal to decrease mortalities
o Specific objectives include seat belts in cars, design, material
o Strategic planning
Approach governments
Approach car manufactures
o Implementation insert into assembly line of car manufacturing
o Evaluation Initially only seat belts in front seats and across waist, this did deaths
but only in front. Evaluated to include backseat and shoulder only around waist
decided to put seat belts in back seat also and include shoulder strap
o Around cycle again further reduction in deaths BUT just because seatbelt in car
doesnt mean people using them so further evaluation decided to introduce laws


START
Collection of information
Establish long term goals
What are your aims?
Specific objectives
Smaller parts to achieve LT goal
Strategic
planning/selection
of programs
Implementation of programs
Evaluation
If it failed why? How can you improve?
Make adjustments - are starting over or
changing aspects?
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2. HEALTH BEHAVIOUR AND HEALTH EDUCATION I


1. Discuss the concepts of Health Education and Health Promotions as they related to Health
Behaviour
2. Explain the rationale behind conceptual frameworks or Planning models when planning Health
Education and Health Behaviour.

Health Education and Health Promotion HE divided into two categories:
1. Informal (what happens at home)
Part of everyones socialization process happens as we grow up
Influenced by family members mostly early on and throughout your life
Eg, dietary habit breast or bottle feed, when we start having solids, oral hygiene, beliefs
and attitudes as we grow up. Did we have floss, did our parents take us for immunization,
fresh fruit or vegetables in our fridge etc.
Usually unaware it is happening
Attitudes regarding oral hygiene transmitted to child long before they see a dentist so can be
difficult to change these behaviours
2. Formal
More planned organized activities
Planned education
Professionals, teachers etc that try to modify behaviour of individuals and communities
Example dentist teaching someone how to brush
Aim to disseminate knowledge, provide quality health care services and if required, free aids
(such as floss) if patients unable to afford
Planning Models and Frameworks
A major problem with HE and HP is how we are going to be effective in changing behaviours
The best way to overcome the problem is to design a effective model/framework to follow
There are many models described often with similar stages but different categorisation
DR D-E has two models; simple and involved Health Belief Model

3. HEALTH BEHAVIOUR II

1. Discuss the Health Belief Model Proposed by Jenkins (1970) and relate to Health Education and
Health Promotion
Health related problems usually involve an interaction:
o Between health professionals and the patient
o Between the environment and the patient (is there any floss at home?)
o Among conflicting beliefs, motives and habits
HBM is a theoretical framework which postulates that individuals will comply with
preventive health care regimens if they view themselves as;
1. Susceptible to a disease believe they are capable of getting it
2. Acknowledge the severity or threat of a disease
3. Convinced of the benefits of the preventive regimen explain that gingivitis is
reversible and if manage now will not progress
4. See few difficulties or barriers in undertaking the regimen can they afford floss, is
there any at home, does the partner think flossing is a stupid idea etc
If patient is convinced of the above four things hopefully they will change behaviour
5

In addition to the above 4 things, there are internal and or external cues that individuals
associate with taking health related actions which are considered important for the adoption
of preventive behaviour:
o INTERNAL happens at home
Positive = mother flosses
Negative father doesnt
o EXTERNAL happens outside the home
Positive = good dental visit (dentist educates them!)
Negative = scary dental visit that results in a phobia
Flossing study of dental students looking at this model of behaviour in 1991 many dental
students even with education still did not floss
HBM is a simple model compared to precede / procede
2. Describe the purpose of and phases of PRECEDE/PROCEEDE Model designed by Green and
Kreuter 1991
This model implies that the key to program planning is a sound diagnostic work up and
the stages are both dynamic and flexible in nature changing as more information is
received, evaluated and interpreted.
o This is for BIG community programs, not private practise
Precede:
Purpose to organise existing theories and constructs (variables) into a cohesive
comprehensive and systematic view of relations, among those variables, important to the
planning and evaluation of HE
Proceed:









More specifically, the PRECEDE/PROCEED heath promotion / planning frameworks (or PP model)
are composed of 2 components:
PRECEDE = the diagnostic or needs assessment phase.
o Gathering all information
o Takes into account the multiple factors that shape health status and helps the
planner arrive at a highly focused subset of those factors as targets (what
needs to be improved upon) for intervention
o It also generates specific objectives and criteria for evaluation
PROCEED = the developmental stage.
o Provides additional steps for developing policy and initiating the
implementation and evaluation processes.
o Takes it a step further (e.g. when big campaign, may need to do this).
These 2 stages work in tandem providing a continuous series of steps or phases in the
planning, implementation and evaluation processes of health educational, health
promotion, and behavioural planning
o All aimed at changing behaviours to healthier behaviour
o Eg, free mammogram screening WA.
Predisposing
Reinforcing and
Enabling
Causes in
Educational,
Diagnosis and
Evaluation

Policy
Regulation and
Organisational
Constructs in
Educational and
Environmental
Development
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Public Health and State funded care
The science and art of preventing and controlling dental disease and promoting dental health
through organised community efforts
Serves the community rather than the individual
Is concerned with
o DHE (dental health education) of the public
o Research, and applications of findings of research
o Administration of programs of dental care for groups
o Prevention through a community approach


Example of Procede / Precede Study on an Individual
1981 study about dental caries and gingivitis using the precede / procede model on a patient. Purpose
was to integrate HE with clinical procedures for management of caries and gingivitis of patient who
started being seen at Dental Hospital at age 4 (patient now 19). Standard HE was only provided at age
15. Patient had caries related to QoL concerns. Clinical findings showed 47 decayed tooth surfaces. Risk
factors were reduced saliva, cariogenic diet, 9-10 sugar exposures per day and diet inadequate with
respect to fruit and veg, OHI inadequate with a 95% plaque score. All treatment and behaviour
All achieved over 6 month study period followed up to 2 years with no new caries & general QoL
improved

Phase 1 Social Diagnoses / Quality of Life
Social diagnosis involves looking at quality of life
Quality of life identification of a persons social and/or quality of life concerns are important.
Subjectively defined problems and priorities of individuals or communities
o Identification of persons social or QoL concerns self study of peoples needs and
aspirations (ie talking to them)
Social indicators (learn one example)
o Absenteeism, achievement, aesthetics, alienation, comfort, crime, crowding,
discrimination, happiness, hostility, illegitimacy, performance, riots, self-esteem,
unemployment, votes, welfare
These are the aspects look at before undertaking big HP campaign
EXAMPLE self esteem is a social indicator, association between health and QoL, girls confidence
low because caries on max anterior teeth, dropped school and unemployed low self esteem
leads to poor OH and poor diet
Phase 2 Epidemiological diagnoses
The task of phase 2 is to identify the specific health goals or problems that may contribute to the
social goals or problems in phase 1.
o Select most important one required for education campaign.
o The problems in phase 2 contribute or linked to problems in phase 1.
Vital Indicators disability, discomfort, fertility, fitness, morbidity, mortality, physiological risk
factors
Dimensions distribution, duration, functional level, incidence, intensity, longevity, prevalence
Based on information collected from phase 1 and phase 2 have social and health goals
EXAMPLE identification of specific health problems; main problem rampant dental caries
(development of 47 decayed tooth surfaces within 3 years since last exam)
o Risk factors reduced saliva, cariogenic diet, diet nutritionally inadequate, high strep
mutans and lactobacillus, plaque score 95%

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Phase 3 Behavioural and environmental diagnoses
Consists of identifying the specific health related behavioural and environmental factors that
could be linked to the health problems chosen as the most deserving of attention in phase 2.
Because this are risk factors, interventions are tailored to affected these and must be ranked in
priority
Sound aetiology of disease is required
Therefore phase 3 affected by phase 2 which is linked to phase 1.
Behavioural indicators compliance, consumption patterns, coping, preventive actions, self care,
utilisation
o Dimensions frequency, persistence, promptness, quality, range
Environmental indicators economic, physical, services, social
o Dimensions access, affordability, equity
After phase 3 behaviour objectives are set
EXAMPLE Environmental indicators are external to individual and out of their control .
Behavioural indicators; diet , frequent snacking, no regular brushing or flossing (ineffective
technique), smoking (25 per day)
Phase 4 Educational and Organisational Diagnoses
Based on cumulative research on health and social behaviour there are 100s of factors could be
identified with potential to affect health behaviour.
3 broad groups are predisposing, reinforcing, and enabling factors.
Give an example of each of these factors for exam
o Predisposing factors include a persons or populations knowledge, attitudes, beliefs,
values and perceptions that facilitate or hinder motivation.
Can be positive or negative
Knowledge, attitudes, beliefs, value, perceptions
o Reinforcing factors the rewards received and the feedback the learner receives from
others following adoption of the behaviour.
Attitudes and behaviour of health and other personnel, peers, parents, employers
etc
o Enabling factors- those skills, resources or barriers that can help or hinder the desired
behavioural changes as well as environmental changes. They can be viewed as vehicles or
barriers created mainly by societal forces or systems e.g. income, health insurance (have
it or not), community resources
Availability of resources, accessibility, referrals, rules or laws, skills
Income can help or hinder, health insurance (big factor enabling factor if do
have),
Related back to behavioural actions of individuals, groups of communities and environmental
factors therefore related back to phase 1 2 and 3
EXAMPLE identification 3 classes of factors for potential to influence her health behaviour
o Predisposing antecedents to behaviour providing rationale, negative attitude to dentists
and standard of care previously low, profound fear due to bad experienced previously,
affected attendance, believed frequent consumption dried fruit good for health but
didnt consider effects on teeth
o Reinforcing previous dental treatment punishing events, perceived going to dentist as
negative punishment, eating used to satisfy pleasure needs
Hers were very negative
o Enabling - eligible to attend dental hospital but organisation emphasis on treatment,
finally referred to preventive department for health education

8

Phase 5 Administrative and policy diagnoses
This phase involves the assessment of organizational and administrative capabilities and
resources for the development and implementation of the program.
Selection of right combination of right methods and strategies
Health education components of HP program
o Direct communication to public, patients, students and employees predisposing
factors
o Indirect communication through staff training, supervision, consultation and feedback
reinforcing factors
o Training; community organisation enabling factors
Policy, Regulation, Organisation
EXAMPLE implementation for program planned (all info from previous phases) come up with
strategy to help adopt more positive behavioural actions
Phase 6 Implementation
Implementation of the program e.g. tv campaign
EXAMPLE Educated girl and treated her
Phase 7-9 Evaluation processes
3 types of evaluation
Evaluation is the most important step in the whole process
Evaluation steps are most important honesty and learning from mistakes.
Phase 7 Process evaluation
Phase 8 Impact evaluation
Phase 9 Outcome evaluation

EXAMPLE
Gave her 4 x 1 hour appointment for education
Plaque disclosing to see if improving each week
She increased brushing and flossing
o This decreased plaque score and gingivitis
20 operative appointments of 3 hours each
o Work on anteriors first to help improve self esteem even if not the worst in terms caries
o Then looks forward to having rest of teeth treated
Self esteem improved
Improved diet and stopped smoking, got job = all positive outcomes
QoL of patient also improved through return to education and eventual employment



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4. SPECIAL NEEDS AND CARE DENTISTRY PART 1 AND 2

***Not necessarily a disability but a condition that requires special consideration***
OBJECTIVES:
1. Define and Discuss the parameters of Special Needs and Care Dentistry
Definitions and parameters Special Needs Dentistry
Is that part of dentistry concerned with the oral health of people adversely affected by an
intellectual, medical, physical or psychiatric disability, regardless of age
Helping anyone who has a disability that prevents them from what we call normal dental
health bad RA or OA cant hold toothbrush well, need different management strategies
Is dentistry for basically anyone who has a disability (who cant independently care for
their own oral health)
o Nursing homes, often difficult to have good oral health due to other commitments
of the staff for medical reasons etc
Is a continuum of care through children, adulthood, geriatric patients
o Arthritis usually develops later in life, but children do develop early and have to
follow them through, or cerebral palsy etc
o Some things contracted at birth and follow through entire life
A geriatric patient defined now as 65 years + (included in SND)
A SN geriatric patient is any compromised adult with one or more chronic, debilitating,
medical, physical, mental of psycho social problems
Traditionally three groups of SN patients
o Hospital inpatients and outpatients that are medically compromised
Cancer patients to have radiotherapy / chemotherapy
o Intellectually and or physically disabled and patients with chronic mental illness
o Frail and functionally dependent older adults
2. Describe the community locations of patients with special needs
Where do patients with disabilities live?
At home
o Living alone with or without community assistance
o Living with parents
o Living with their children
Residential care retirement villages with tiered levels of medical care
Aged care facilities (nursing homes)
Hospitals (long term) or mental hospitals
Ronald McDonald House kids with cancer from rural areas, parents can stay here
In prisons
On the streets
Although at any one point in time only a small proportion of our older population lives in
residential care, the likelihood of future need for use of residential care is high , older
adults will require permanent housing and doubles for 80+, higher for females as living
longer
Will require more care facilities for these patients
3. Explain the important dental considerations regarding these patients
Communication with patient and carer also
o Most important consideration
o Deaf patient, do they want to be considered hearing impaired or deaf other
patients dont mind
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o Establish first off how they want to be referred to they are a person first
o patient with cerebral palsy not disabled person with cerebral palsy
Time management appointment length, patient stamina, how long they can sit
o May need to discuss with the carer
o If patient cant sit still may need to consider GA
o Some patients better first thing in the morning, or later in the afternoon
o Schedule them as the last patient of your day or right before lunch (if they can), so
if you run over with them not interfering with other patients
Access to the oral cavity / limited by your equipment tremors, limited opening, use of
bite blocks etc
Patients capacity to understand better to think they can understand you than they
cant, dont want to upset them by talking down to them
Patients ability to get into the chair wheelchair, is dental unit compatible or accessible
Ability of patient to cooperate patients with tremors want to help, but cant control the
tremor
Consent sometimes need to get from carer rather than the patient, if they dont
understand, need to ascertain this
Current health status medical history and medications often change regularly, always
ask when you see them and be vigilant
Radiographs will you be able to take them, many have exaggerated gag reflex, might
have to use an OPG only
Shaking and other unexpected patient movements related to communication, if patient
has says they shake and is acceptable to restrains etc
Financial considerations
Denture labelling often mixed up / lost in nursing homes
Caries (especially root cares) and PDD
o Two most common dental diseases in this group of patients
o Many cant brush the gingival 1/3 of the teeth, or nursing home staff rushed
o Not / cant floss leading to increase in PDD
o Primary cause of these conditions is inadequate OH either by patient of carer
o Dentures may not be cleaned properly either and mucosal lesions of fungal origin
may occur
4. Discuss the AODL that promote dental health in special needs patients
Activities of Daily Living
Talking
Eating (food selection) , chewing (number of times required), swallowing (can they do it)
Brushing and flossing if not, how can you help them,
o Interfere with dental health if cant do these things
Rinsing
Walking
Seeing and observing when teaching how to brush
Hearing
Dexterity level
o Flossing wands
Source of income can be hinderance
Ability to go to shops
Cooking and cleaning
If the patient cannot carry out these activities, the carer is the most important person in their lives,
therefore carer training is imperative and vital!!
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5. COMMUNITY DENTAL HEALTH PROGRAMS:
PREVALENCE OF ORAL AND DENTAL DISEASE (EK)

What is health (WHO definition) state of complete mental, physical and social well being and not
merely the absence of disease or infirmity

What are the determinants of health? Causes of oral disease
Genetic factors
Lifestyle factors close association with oral health (smoking, alcohol, combination biggest risk
for oral cancer)
Nutrition and diet particularly on dental disease
Occupational health
SE factors strongest variables associated with oral health
Strong association with poor oral health and poor SE status (throughout world)
Environment
Others
Issues facing public health
Economic globalisation rely on public funding and tax money
Environmental hazards
Global environmental degradation
Ageing population huge concern in Australia, ageing rapidly spending most health money on
people 65+, insufficient planning for this
Double burden of disease
o People have 3
rd
world diseases (in Aust) but have combined 1
st
world lifestyle diseases
More than 1 Billion in absolute poverty
Infectious diseases increasing
Burden of oral disease
Oral health not just narrow term, broad
Teeth and gums
Oral mucosa
Cancers of mouth and through
Malocclusion
Birth defects
TMJ problems
Trauma to jaw / mid face
Consequences of oral disease
Pain, infection and tooth loss
Destruction of ST in the mouth oral cancers
Difficulties with chewing, swallowing or speech on daily basis can lead to other problems
nutrition deficiency and diet poor, lead to other systemic diseases
Disrupt sleep and productivity
Socio-dental impact = impact of self esteem, psychological and social well being, quality of life
Deterioration of diet, compromised nutrition due to tooth loss, especially in elderly
o Not everyone functions well with dentures
Death cancers, infections
o Childrens toothache deaths signal backward step for nation 2007
o Children dying due to spreading dental infections
o Australia has SDS which prevents a lot of diseases otherwise would go untreated
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Dental Caries
How does Australia rate?
In Australia caries experience of children until 1996
Started programs of water fluoridation and F- toothpaste
Since 1996 both the prevalence and severity have diminished (1997-2001)
Plateau in current caries experience
Good compared to international standards SDS helps
DMFT
o 5 year olds 2001 1.81
o 12 year olds 0.95
DMFT of 12 year olds better because loss of decayed primary teeth, permanents fairly new some
not in mouth very long
DMFT for all ages = 12.8 (2004-2006)
Increase in DMFT as age increases
Females less untreated decay, but more fillings
o Take more care of themselves
25% of Australians have untreated decay
Those born since 1970 had the level of decay that their parents generation had when they
were young adults
o Drastic improvement water fluoridation, F- toothpaste, general improvement in
housing, diet and income (impact on health and oral health)
Number of missing teeth has declined more options available for retaining teeth
DMFT
Measure caries experience how much they have had up to that point in time
Decayed, missing or filled teeth
DMFT can never go down
Can changed D to F or D to M (if extracted)
DMFS surface; much more detailed measurement
Prevalence how many people have ANY caries ( score 1+)
o If class had then prevalence = 50%
Severity the actual caries score D+M+F
o If average in a class 2.5 severity in class 2.5 and prevalence 50%
Periodontal disease
1 in 5 Australians have moderate PDD (2004-2006: figures from national health survey)
Only 2.4% have severe PDD
Very strongly related to age
No data available to assess the trend in PDD prevalence or severity
Tooth Loss
Edentulism increases with age
Rates fallen over last 20 years
Trend reflects changes in dental practice rather than prevention
Other options rather than extractions now
National data for prevalence
o All ages = 6.4%
o 15-34 = 0%
o 35-54 = 1.7%
o 55-74 = 14%
o 75+ = 35.7%
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Malocclusion
Only national data available from 1988
54% of Australians had no malocclusion
12% had severe malocclusion
11% needed some treatment
6% were having / had completed orthodontic treatment
Now treatment has increased more kids having ortho done than in the past
Oral Cancers
Represent
o 4.5% of new cancers in males
o 2.3% of new cancers in females
Prevalence of oral cancers higher in males in general
In 1996
o 2372 new cases diagnosed
o 717 Australians died from oral cancers
Incidence has increased slightly
o Lip cancer considered oral cancer in Australia
Twice as likely to affect men than women due to risk factors
Cleft lip and palate
1996 178 babies born with either CP, CL or CLP
From 1987-1996 approx 6.1 cases of CP and 9 cases CL per 100 000 live births per year
o Relatively rare
But needs treatment quickly and lifelong
Oral trauma
Australians admitted to hospital for oral injury at rate 66.6 per 100 000 people
This only includes hospital admission where oral injury is principle diagnosis
o Not inclusive of other injuries where oral cavity also injured
By age 25 2.5% of Australians and 7% of males have had a hospital admission for oral injury
Variations among population sub groups oral health status varies by age, social group and economic
status
Groups with pressing dental needs
o Frail aged person
o Indigenous Australians
o Migrants especially refugees
o People living in rural areas
Children wide variation within children of these groups
o 6 year olds
More caries experience in rural / remote
More caries in lower SE quartile
More untreated decay in indigenous children
o 12 year olds
More caries experience in rural areas
More caries in children from non-English speaking backgrounds
Young Australians
o 24% of 15-34 year olds have no caries experience
o Mean DMFT in this age group is 4.5
o Variation in this group is associated with economic status and use of dental services
Adults
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o Higher rates of edentulism in women, rural / remote dwellers and those eligible for public
dental service
o Because go more often, get extractions done
Older Australians
o Nursing home residents very poor oral health
o Oral health not priority as other medical issues
o Oral health in this age group of particular concern rapidly expanding group
o Life expectancy increasing
o Chronic and systemic disease associated with poor oral health
o In all age groups but particularly elderly
Indigenous Australians
o DMFT 14.8 compared to 12.8 for a non-Indigenous person (2004-2006)
o DMFT for children almost entirely D component untreated decay
As opposed to treated caries in non indigenous
o Older indigenous have high M component
o Inadequate access to services most are in the rural and remote area with lack of
services
o Missing teeth associated with high rates of diabetes and advanced PDD
o In general worse periodontal health than general population
o Hospitalisation for jaw fractures in WA (1999-2003)
Aboriginal males 22X more likely than non indigenous male
Aboriginal female 23 X more likely than non indigenous female
Both peak at young adulthood
Social Impact
Oral Health Impact Profile (OHIP) was developed to capture facets of social impact of oral
disease
o Ability to eat, communicate, socialise, psychological impact etc
OHIP for working Australians indicates prevalence of problems with;
o Functional limitation
o Physical pain
o Psychological discomfort
o Physical disability
o Psychological disability
o Social disability
o Handicap
Dont see these things when examine the patient can only assess by asking the patient of their
perceptions
o Just as much of an impact as tooth ache etc
Summary
Proportion of Australians retaining own teeth and number of teeth retained into old age are
growing
Decreased edentulism
But this part of population growing huge population of elderly with own teeth, and need to
look after them
Higher rates of edentulism and tooth loss evidence in
o Frail and functional dependent
o Oldest of the old
o Women
o SES disadvantaged
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o Low levels education
o Indigenous Australians
o Chronic mental illness or neurological impairment
Indigenous Australians have poorer oral health than Australian population as whole
7.9% of indigenous edentulous compared to 6.4% of non-indigenous
Refugees arrive with poorer oral health status than general population
Older Australians in rural areas more likely to be edentulous
People with lower education status and less skilled occupation groups experience higher
edentulism and extractions
Social determinant of oral health
o Health inequality mirrors social inequalities
o Social determinant of general health also associated with oral health
Oral health isnt separate
o This has implications for oral health promotion and individual and societal levels


Would OH status of population be better if increased access and all free?
Slightly better because some groups that access and cost is an issue
Rest of the population, not necessarily people dont take responsibility for own health
Reason dont go to dentist not cost, access, time etc = they dont think its important, cant be
bothered etc, if dont feel pain thing everything is ok, not priority, dental anxiety
Not all problems solved by providing more dental services dont overestimate contribution of
dental services




16

6. COMMUNITY DENTSITRY DENTAL HEALTH PROGRAMS (EK)

Parts of the population with access
In Australia most dental services delivered in private practice 80% to private patients can afford
to pay
Public clinics provide services to people who cant afford to pay, health care cards or
concession card
o Waiting lists, might not be close and need to travel
In the middle, not wealthy enough to go private but not poor enough to have a concession card
they have problem with accessing dental treatment
o Not covered by medicare, need pay out of pocket
o Dont usually see these patients
Planning for Community programs
1. Policy development
2. Decision making
3. Program planning
System more complex than the one in the dental office
o Public health = dont work with an individual patient you work with a community
o Approach slightly different to planning for treatment for large groups of people
o Planning for a group of people more complex than for one.
May be a community, organisation, corporation, institution etc.
o First need to find out what the community is at and what they need
Planning dental care
Provision of dental care for a private patient vastly difference compared to provision of dental care for a
community
Private Patient Community
1. History / clinical exam
2. Diagnosis
3. Develop treatment plan
4. Obtain patient consent
5. Select appropriate labour
6. Select appropriate dental service
Preventive, restorative,
endodontics etc
7. Evaluate treatment
Examination, radiographs, oral
hygiene, patient satisfaction

1. Community survey
select a sample of people representative of the
community
2. Analysis of survey data diagnosis
3. Develop program plan
4. Obtain community approval
5. Select appropriate labour
Dentist, hygienist, therapist, teachers, social workers
etc
6. Select appropriate activities
water F, fluoride rinse program, oral cancer screening
etc
7. Evaluate program
Compare baseline survey with later survey
Attainment of goals / cost effectiveness /
appropriateness / community satisfaction


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Definition of planning decision about a course of action
Needs assessment
Define the problem caries in children, PDD among elderly etc
o Know what problem is, depends on the community demographics
Identify its extent and severity.
Obtain a profile of the community to ascertain causes of the problem
o High or low SE status
o Demographic profile
o Males, females proportion
o Age
o Educated not educated etc
o Access to health services
o Employment
o Housing
o Diet
Need all the above baseline information so comparisons can be made later after the completion
of the program
o Used to evaluate the effectiveness of the program later
For oral health programs, need them to run for a long periods of time
o May start to see changes after two years
Flow diagram of the process


Identify problem
Needs assessment + collect the data + analyse the
data
Determine priorities
Develop program goals, objectives and activities
Identify resources, constraints, alternative strategies
Choose most effective activity
Develop inplementation strategy
Implement + monitor + evaluate + review
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Planning cycle continuous process

Proposed by the planner
Process needs to go through many steps and people
What you get at end may not be what you asked for
End up with things that arent working, not cost effective
Community programs
Children
Why do we focus on children?
o Dependent on others, represent and investment in nations future, least expensive to
cover.
o Save money now by preventing things, wont be spending treating them as adults
o Biggest dental public health program is aimed at children.
Prevent dental programs at a young age can save money later
1970s Commonwealth government funded development of infrastructure and education of
dental therapist
o Start of the SDS
Funding largely form consolidated tax revenue
Co payments in some states every states runs their own SDS so slight differences in how run
and funded
Services provided basic restorative and preventive care.
o If the therapist cannot do, or outside their scope, referred to the dentist
o Some dentists working for SDS also
SDS covers more than 80% of children in WA
Adults
Public dental services are available
o This are available only for means tested, eligible adults and adult independents
o Health card holding evidence of eligibility
Some states and territories have co payments not completely covered
Predominantly emergency services, mix of diagnostic, oral surgical and miscellaneous services.
Eligible Department Of Veterans Affairs (DVA) beneficiaries entitled to full range of dental
services for war caused conditions and for all conditions for some
o Provided by private dentists and specialist
Armed Forces and Army Reserve dental scheme provides members of the defence force with full
range of services at no charge

Goals
Objectives
Identification of
alternatives
Assessment
Choice
Implementation
Evaluation
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Others disadvantaged and special groups
Public general dental services are also available to specific population groups
Services to Indigenous Australians through Aboriginal health services
o Clinics in WA 7 attached to medical centres, fly-in/fly-out dentists
Services to refugees and through ad hoc dental programs
Services to prisoners through prison health system
Provision of access to orthodontic and OMS care in most major centres or capital cities
o Most have long waiting lists where these services exist
o Some stages have contracted orthodontic care for eligible children to private practise or
provide travel assistance to orthodontics
Community dental health departments target geriatric and social care patients offering
domiciliary and boarding house dental services
Some private dentist provide services to nursing homes on an ad hoc and individual basis,
restricting care to emergency and palliative services
Innovative programs
Employer run clinics a lot in America where companies have their own dentist
Privately provided, publicly subsidised rural programs
Mobile dental services and consulting sessions in youth centres quite active in Sydney
Portable services for housebound / residential care patients
Mobile services in some remote communities
o SDS in remote communities in WA is mobile
Rural placements / voluntary intern placements
o Rural intern year

7. INSTRUCTIONAL / EDUCATIONAL / BEHAVIOURAL OBJECTIVES

Format you need to follow to come up with instructional objective
Objective = one sentence stating what want to teach, made up of 3 parts
How to write proper instructional objectives 3 areas
1. Introduction
Upon... completion of my lecture / viewing poster / seeing demonstration
2. State behaviour / performance
.. the students (audience, participants, group, community) will be able to
Action verbs measure or examine, identify, explain, discuss, describe, label
Non action verbs appreciate, understand
3. Special criteria not always specified
...100% of the time, to the pass rate of 80%, to the best of their ability etc
For poster dont worry about this
Flossing would be a behavioural objective as wanting to change behaviour



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8. DEMOGRAPHY & ITS RELATIONSHIP TO HEALTH CARE PLANNING

OBJECTIVE Discuss concepts of demography (under headings) as they relate to health and health
promotion

DEMOGRAPHY
The study of populations with respect to age, sex, geographical distribution, civil status, cultural
and socio-economic conditions.
It includes factors which affect population development and the consequences of changes in the
composition of the population.
Similar to epidemiology (population epidemiology) same techniques are used, both use
statistical methods and descriptive and analytical components.
Segment of demography which pertains to dynamics of populations (birth, deaths, marriages)
called Vital Statistics
Why demography is important for planners
o Many decisions for populations depend on demographic factors:
o Knowledge of demography of population is essential for planners.
o Examples of decisions depending on demographic factors
where are the children, how many of them are there, are their numbers rising or
falling, should a new school have one or two dental surgeries
how many elderly are there and where do they live
How many roads should be built
What size of power station is needed
Where to put schools/health centres
o Oral health care planners need to know about the population
Children/elderly populations of each region
Increase/decrease child population
This can be used to determine how many school dental surgeries are required.
SIZE AND GROWTH OF POPULATIONS
Size is most important measure of a population how many people comprise a state or region
Populations are measured by
o Estimation used if better data is not available (developing countries)
o Census used since Roman era, it is still used now in Australia and other countries.
o Continual / population registration some countries, therefore dont require census for
populatin but may still use census for other data (educational levels, socioeconomic
status, religion)
Australia first census in 1828 NSW, 1848 WA, 1881 simultaneous censuses in all Australian
colonies, 1911 first national census. Since then censuses occur periodically.
In Australia population increase due to 2 main factors
1. Natural increase (births minus deaths)
2. Net immigration (immigration minus emigration)
Before 1861, immigration was main contributer, since then natural increase has
been most important and immigration is most variable.
Late 1980s immigration exceeded natural increase (though it has recently
declined) due to changes in immigration policy and economic recession
From 1858 to end of 1991 population changed from about 1 million to about 17
million Australia wide (with WA having about 1.5 million at the end of 1991)
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1990 WA has the highest state growth rate in Australia due to high natural growth
(9.8/yr/1000 persons) and net immigration (from overseas/interstate
14.4/yr/1000 persons)
Annual Rate of Growth
Expressed as a percentage or number per thousand
The following calculation determines annual rate of growth per
thousand in the population
Rough method

o P
1
population at the beginning of the period
o P
2
population at the end of the period
o T length of period in years
For longer periods, formula becomes inaccurate as the population growth is normally
exponential.
Constant annual rate of growth of
o 10 per 1000 = double the population in 70 years
o 20 per 1000 = double the population in 35 years.
o 30 per 1000 = double the population in 23 years
Annual natural growth rates > 20 per year per 1000 characteristic of developing countries
High growth rates problems pressure on societys infrastructures i.e. water/sewage services,
schools, roads and health facilities.
Studying Population Trends
Can (attempt to) predict future population size on the basis of present population size and
trends
Three predictions are prepared
o Lowest
o Most likely
o Highest prediction
Many factors alter population growth and are hard to predict
o Australia the biggest unpredictables are rates of immigration and emigration (vary in
response to economic and political factors). Australian mortality rates are relatively
constant.
o Other countries disease and famine still play role in determining population size.
o Modern society Fertility of women of child bearing age is a consideration especially
since there is more women joining the work force.
DESCRIPTIONS OF POPULATIONS
Register age and sex composition of the population
Information is traditionally presented graphically in a population pyramid
Pyramid architecture
o Base is the 0 year population, as you ascend to the apex the bars
depict the population in higher age groups.
o High population growth = triangle shaped with wide base and
narrow apex
Mainly young population
o Low population growth = pyramid relatively parallel sided
Equal number of young and old
o Compare developed and developing countries
Median Age
Population statistic
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Age which divides the population into 2 equally sized groups
o the population is older and the population is younger.
In Australia: median age is 31.3 years in 1987, should increase to 36 years by 2011.
Masculinity Ratio
The masculinity ratio is the proportion of males per 100 females.
Generally more males in younger groups more males born
BUT the proportion of males will fall with increasing age as mortality among males is higher at all
ages.
Equilibrium age
o If we disconsider immigration then there would be equal numbers of males and females
at about 51 years (this is the equilibrium age).
o As the difference in mortality between males and females gets less, the equilibrium age
rises.
Less chances of dying from illnesses, fewer accidents, fewer violent deaths (which
tends to involve males)
o Immigration into Australia used to be mostly males to boost the equilibrium up on the
male side, but recently (1987) there is about 105.8 males to every 100 female immigrants
DEMOGRAPHIC FACTORS
Educational level and employment
Demographic factors of interest in dental public health as they are associated with distribution of
oral disease.
In developed countries children of parent with higher education have less dental caries than
children of less educated parents.
o Basically literate parents can understand written health information versus the illiterate
person.
o Poor language skills present similar barriers consider immigrants
Measures of education
o Income tax statistics can determine income data
o Questions about educational level (which relates to income level)
o Labour force surveys in Australia published by the Australian Bureau of Statistics.
Residence pattern and mobility
Residence pattern of Australia is primarily urban (85.4%)
16% of people 15 years and older shift residence each year, 10% of which is interstate.
Housing and employment are primary reasons for moving.

POPULATION DYNAMICS
In Australia, live births, deaths, marriages, divorces are registered to the state/territory in which
they take place
Live births delivery of a child, irrespective of duration of pregnancy, who after being born
breathes or shows other evidence of life
Fertility
o Actual reproductive behaviour of the population
o Observed by registering the number of children born.
o Fertility varies greatly between societies and within a society between different times.
o Determinants social, economical, cultural factors.
Fecundity
o Societies reproductive protential maximum biological ability to produce children
o Upper limit of fertility
o Difficult/impossible to measure accurately.
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o Fertility is never as high as fecundity
Birth rates most common measure of fertility
Crude birth rate
o Most common measure of fertility = number of live births per 1000 population per year
o Crude because it takes no account of the composition of the population


o ADVANTAGE calculated approximately the same way as crude death rate to allow quick
comparisons between the two.
o DISADVANTAGE because the total population is used as a denominator, the crude birth
rate is misleading in populations with a disproportionate number of males or of females
outside a fertile age.
General fertility rate
o To adjust crude birth rate for the above consideration calculated GFR
o This thus describes the number of births related to the female part of the population.
15 44 years are not the lower and upper limits for mother hood they are used to
get standard and internationally comparable figures.

Age specific fertility rates
o A limitation of GFR is that it does not take account of the age distribution of women from
the age span of 15-44 yrs.
o So instead age specific fertility rates is used and calculated in similar way
o From this calculation total fertility rate is derived
Estimate of the total number of children a woman will produce throughout her
child bearing life.
Total fertility rate of 1910 per 100 women = each woman will produce 1.91
children.
Net reproduction rate
o Mean number of live births of a female that is born to a woman who survives all her
fertile life (15-44 years).
o What extent the female population reproduces itself.
o NRR < 1 = long term tendency is population decline
Unless compensated by net immigration as in Australia
o NRR > 1 = long term tendency is population increase
Mortality rates
Monitors chronic diseases and other health problems
Data derived from information provided on death certificates
ADVANTAGES
o Coverage is universal as deaths must be reported
o Certificates have standard format definitions and data presentations are well
standardized by health authorities and WHO.
Crude mortality rate
o Proportion of a defined population who die in a given period.
o Crude because it takes no account of associated factor like age/sex.
24







o Unit of mortality rate is yr
-1

Often the rate is multiplied by 1000 to express deaths per 1000 persons per unit
time.
The unit time is normally a year but the rate will vary depending on the duration
of the period
If the period is very long, the rate will approach unity.
A low figure may indicate that there is a large number of young persons
o Age specific mortality rate of younger people is lower, and if there is many in the
population then they draw the crude rate down.
o In mature countries with more stable populations, there is proportionately more older
people and thus a higher mortality rate.
o To compare mortality rates between countries, mortality rates should be standardized or
age and sex specific rates should be prepared.
Age and sex specific mortality rates
o Derived by restricting the populations to males OR females
o Rates are grouped into 5 year bands
Males or females from 1-4 years, 5-9 years, 10-14 years etc.

o Mortality rate for men is higher than women at all ages and females can expect to live
longer than males.
o Life expectancy increasing in almost all societies mainly due to falling infant mortality
rate
Infant mortality rate (IMR)
o Measure the risk of dying during infancy it is a particular age specific mortality rate
o Infancy defined as between birth to 1 year
o Measures deaths (under 1 year old) as a proportion of number of births
Number of births is the population being assessed
o Varies between 0 and 1 and has no dimensions






o Valid indicator of societys health status and is easy to record.
o Can be subdivided into neonatal mortality rate and post neo natal mortality rate
The sum of which equals IMR
o Neonatal mortality rate = total number of deaths under 28 days of age in a population in
a given period.
Related to congenital factors and prenatal influences
o Post neonatal mortality rate = total number of deaths of infants 28 days to 1 year in a
population during a given period.
Related to environmental factors infection, living conditions

25

Potential years of life lost (PYLL)
o Expresses the social cost of a death.
o Homicide and motor accidents have a high social cost as deaths can occur in young
people rather than the elderly
o Young have a greater life expectancy.
Underlying causes of death
o Sometimes reported as many chronic conditions result in debilitation which result in
death from something like pneumonia or influenza.
o Doesnt give good information on chronic disease prevalence in the population
Immigration and emigration
o Significant contributors to population changes
o Exceeded natural growth in 1988-89 but more recently it is less than natural growth
Standardisation
Death rates and disease rates (especially chronic diseases) vary with age.
Need to use age standardization to allow vital statistics to be comparable across populations.
o Allows comparison disease rates of different populations as if the two populationshad
identical age distributions.
o Only meaningful if compared to other rates standardized in the same way and to the
same population.
o After age standardization remaining differences in disease rates between populations
must be explained by factors other than age.
Standard age distribution
o Choose an age distribution to use
o This could be the age distribution of one of the populations concerned or another known
age distribution.
o The choices is arbitrary
Standardised rate
o Standardized rate is the weighted average of the category specific rates.
o Weights are taken from the standard age distribution by dividing it into age categories (0-
9, 10-19 years etc)
The proportion of the standard population falling in each age category comprises
the weight given to that category.
SUMMARY
A situation analysis to be used in the planning of health care should include a demographic
description of the community to be covered by the service.
Can use the measures described above
May need additional measures to be developed depending on the region to be served and
population characteristics



EXAM REVIEW
1. General definitions, HP, HE and differences between them
2. Planning cycle different ones, use the cycle she gave in class
3. Health believe model
4. Precede / Procede model
5. Demographics when undertaking large health promotion campaign need to study area you are
going to target. Summarise under headings, at least one equation