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Community Dentistry Years I - IV

Community Dentistry Years I - IV. Dr David Locker Room 521 (ext 4490). Year I: Term I. Epidemiological methods Epidemiology of oral diseases Determinants of health and disease. Year I: Term II. Current issues in dental health care. Year II: Term I.

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Community Dentistry Years I - IV

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  1. Community DentistryYears I - IV Dr David Locker Room 521 (ext 4490)

  2. Year I: Term I Epidemiological methods Epidemiology of oral diseases Determinants of health and disease

  3. Year I: Term II Current issues in dental health care

  4. Year II: Term I Clinical epidemiology and critical appraisal

  5. Year II: Term II Evidence-based care: small groups learning

  6. Years III and IV Communication in dental practice Psychological and behavioural issues in dental practice Ethics in dentistry Jurisprudence

  7. Years I and II Providing clinical care to patients ? What is the evidence re: benefit? Is the evidence high quality? Is the evidence relevant?

  8. Year 1: Fall Term Lecture 1

  9. Introduction to Epidemiology OBJECTIVES: Nature and scope of epidemiology Contribution to dentistry and dental practice

  10. Two Types of Health Care Clinical Practice: • Treats individuals • With physical and psychological disorders • Aims to RESTORE HEALTH Population (Public) Health Practice: • “Treats” communities and populations • Currently healthy • Aims to PREVENT DISEASE and MAINTAIN HEALTH

  11. Scientific study of the frequency, distribution and determinants of health and disease in human populations

  12. Causation EXPOSURES INTERVENTIONS OUTCOMES

  13. All decisions that health professionals make health professionals make involve assumptions about causal mechanisms

  14. Aetiology: Risk factors Disease Therapy: Treatment Improvement in patients condition Health service Health services Improved delivery: community health Causal Relationships in Health Care

  15. Comprehensive understanding of oral health and disease • Understanding of scientific methods • Causes of oral disease • Evaluation of interventions • Role in decisions re: diagnosis and treatment for the individual patient

  16. SCIENTIFIC METHODS CRITICAL APPRAISAL EVIDENCE BASED CARE

  17. Characteristics of Epidemiology • Science • Populations and population sub-groups • Prevalence, incidence and risk

  18. Science A systematic set of methods for producing knowledge about events and their relationships which eliminates chance, bias and error.

  19. Power of Epidemiology 1854 London cholera epidemic 1940 Fluoride and dental caries 1970 US toxic shock syndrome epidemic

  20. London cholera epidemics1848-1854

  21. 83 Deaths* 5 In families sending to Broad St. pump for water 61 Known to have drunk pump water 6 Believed not to have drunk pump water 6 No info 3 Children attending school near pump 2 No info 73 living near Broad St. pump 10 not living near pump * Out of 83 individuals who had died of the disease, 69 were known definitely or could be assumed to have drunk the pump water, 6 were believed not to have drunk it, and for 8 there was no information Table 1: Results of Snow’s Investigation

  22. Fluoride and dental caries(see attachment)

  23. Mechanisms by which fluoride considered to inhibit dental decay 1. Pre-eruptive - reduce enamel solubility

  24. Mechanisms by which fluoride considered to inhibit dental decay 2. Post-eruptive - promote remineralization - inhibit bacterial acids

  25. Fluoride mechanisms Better understanding of mechanisms Debate re: modes of delivery

  26. Toxic shock syndrome

  27. Epidemiology is a logical discipline which proceeds by way of sequence of reasoning • It is a comparative discipline in which causes of disease are identified by comparing its frequency in different groups • Epidemiological investigations can lead to reductions in the frequency of disease even though biological mechanisms are not known

  28. Two Approaches to Explaining and Controlling Disease Environmental: Focus on environmental, behavioural, lifestyle causes of disease Mechanistic: Focus on biological and pathological mechanisms which cause disease

  29. LUNG CANCER CARCINOGENESIS SMOKING

  30. Sequence of epidemiological reasoning Observation Suspicion Hypothesis

  31. Epidemiological study Statistical association Causal inference Prevention

  32. Types of Epidemiology Classical: Field epidemiology Descriptive epidemiology Modern: Analytic epidemiology Experimental epidemiology Clinical epidemiology Molecular epidemiology

  33. Current Applications of Epidemiology • Identifying a new syndrome and its cause • Assessing risks of exposures to harmful agents • Identification of high risk groups • Effectiveness of treatment and preventive technologies • Needs for and trends in use of health services • Variations in diagnosis and treatment planning among practitioners

  34. What is the oral health status of Ontario’s elderly? Is there an association between smoking and the onset and course of periodontal disease? Does community water fluoridation increase the risk of hip fracture in the elderly? Does the use of dental services by adolescents decline after school dental programs cease?

  35. How does chronic facial pain affect the quality of life? Is this improved following consultation and treatment at a specialist pain clinic? How much variation is there in dentists’ diagnoses of caries based on radiographs? What proportion of the population avoid dental treatment because of fear and anxiety, and how is this changing over time?

  36. ? Does oral infection (periodontal disease) increase the risk of major systemic disorders such as heart disease, stroke and low birth weight?

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