Community Dental Health

1. Community Dental Health Final Review Algonquin College - Jan Ladas

2. Errors Type I (Alpha): • Is made when we reject the null hypothesis when, in fact, it is true, therefore could lead to practicing worthless treatments that do not work. Type II (Beta): • Is made when we do not reject the null hypothesis when, in fact, it is false, therefore could lead to overlooking a promising treatment. e.g.: the law – “innocent” or “guilty” Algonquin College - Jan Ladas

3. Statistical Significance Two Groups Research Designs Student’s “t” test for statistical significance: • Compares the means of 2 groups to determine if difference between them is real or a result of sampling fluctuation under conditions of ho (no difference) • Best if applied to results where 2 groups received different experimental treatments • Used when population standard deviation is not known Algonquin College - Jan Ladas

4. Statistical Significance Multiple Groups Research Design: • Analyses of Variance Test for Statistical Significance = ANOVA – f value • The test to determine whether differences in multiple group scores have occurred by chance (sample fluctuation) or by applied experimental manipulation Algonquin College - Jan Ladas

5. Statistical Significance ANOVA compares the variability in 2 ways: 1. Between Group Variance (BGV): • Referred to as treatment effect • Reflects the magnitude of the difference among the group means • Number of d.f. for BGV is calculated by the formula K – 1 where K stands for the number of groups Algonquin College - Jan Ladas

6. Statistical Significance 2. Within Group Variance (WGV): • Referred to as residual effect • Pooled variance of all the groups in the design added together • This variance represents the uncontrolled, unexplained variance due to the chance effect Algonquin College - Jan Ladas

7. Statistical Significance Chi-square test: • Compares observed and expected frequencies not means • Best used with discrete variables where subjects can be assigned to mutually exclusive groups E.G.: Males, females, smoking, non-smoking • Based on the normal curve and degree of freedom • Chi-square value calculated and compared with pre-set critical value before accepting / rejecting Ho. Algonquin College - Jan Ladas

8. Correlation • Refers to the linear relationship between two variables • Statistical measure for determining the strength of the linear relationship • Based on the number of variables, nature of variables (discrete or continuous) and the scale of measurement. (nominal, ordinal, interval and ratio) Algonquin College - Jan Ladas

9. Correlation Analyses Used to determine the relationship between variables each of which can be measured for each individual in the sample e.g.: - height and weight - profit and loss Algonquin College - Jan Ladas

10. Correlation Analyses The analysis yields a measure called: Correlation Coefficient known as Pearson’s r. • Measures the direction and strength of the relationship of the two variables to produce the numerical correlation ranging from –1.0 to +1.0 Algonquin College - Jan Ladas

11. Variables The items of a study that are measured. Independent variable(s) (intervention): • All the factors that influence the characteristics which are under investigation • Some of the independent variables will be manipulated as part of the study or experiment = “controlled” I.E.: Age, gender, type of oral hygiene aid, amount of drug administered Algonquin College - Jan Ladas

12. Variables Independent variable(s) (intervention): “Uncontrolled” variables can not be manipulated: • Subject’s prior experience • Subject’s knowledge base • Subject’s emotional state • Subject’s values, beliefs I.E.: Dental hygienist evaluating tooth brushing method for children = “controlled variable” Algonquin College - Jan Ladas

13. Variables Dependant variable(s) • The measurable result or outcome which the researcher hopes will change or not change as a result of the intervention • Their values are determined by all of the independent variables operational at the time of the study (both controlled and uncontrolled) N.B.: Called dependant because result depends on independent variable E.G.: Subject’s plaque scores / gingival condition (Measured before and after) Result depends on method used. Algonquin College - Jan Ladas

14. Four Types Of Scales 1.Ordinal Scale: Discrete categories are ranked in increasing or decreasing order. E.G.: Grades: A, B, C … letters Conditions: worse, fair, good State: no treatment needed, treatment needed, urgent treatment needed - No comparison can be made between categories. Algonquin College - Jan Ladas

15. Four Types Of Scales 2. Nominal scale: Discrete categories are named or labeled for identification purpose. E.G.: Green, tall, defective, yes/no, voting list • No quantitative relationship to each other • Weakest scale Algonquin College - Jan Ladas

16. Four Types Of Scales 3. Interval Scale: Data conforms to a measurement scale with fixed units. No absolute zero point. Differences between points can be measured. E.G.: Thermometers (0 is a temperature). 4. Ratio Scale: Data conforms to a measurement scale with fixed units with an absolute zero point. Differences between points is the same. E.G.: Weight scale, age (birth to 5 years), exams (0 to 100 marks). Algonquin College - Jan Ladas

17. Epidemiology • The study of the amount, causes, distribution and controls of diseases and health conditions among given populations. • It attempts to determine which associated factors are important for prevention and control e.g.: Colorado Brown Stain Study Algonquin College - Jan Ladas

18. The Uses of the Science of Epidemiology   1.Description of normal biologic processes Examples: stages of growth, blood groups, and times and order of tooth eruption.  2. Understanding the natural history of diseases. Observations of disease progression and outcome in populations have enabled investigators to distinguish those diseases that are fatal or disabling from those that will resolve uneventfully. Algonquin College - Jan Ladas

19. The Uses of the Science of Epidemiology 3.Distribution of disease in the population. By age, gender, race, geographic region, and socioeconomic status. Demonstrates trends in disease prevalence and distribution. (Study of patterns among groups). 4.Studying non-disease entities. Suicide, injury. Algonquin College - Jan Ladas

20. The Uses of the Science of Epidemiology 5.Identifying the determinants of disease. Specific study designs can identify the risk factors and risk indicators associated with a disease and can lead to intervention strategies for prevention and control. 6.Testing hypotheses for disease prevention and control. Dental example: the various uses of fluorides to reduce caries incidence. Algonquin College - Jan Ladas

21. The Uses of the Science of Epidemiology 7.Planning and evaluating health care services. Data can be used to assist planning decisions on services and types of personnel required. Validates the effectiveness of treatment techniques and quality of treatment provided. Algonquin College - Jan Ladas

22. Epidemiologic Studies/Research Descriptive, Experimental, Analytic Every study/research, no matter how modest, needs a Protocol. • A written plan containing the purpose and detailed operation of the study • Helps it’s design • Helps researchers to anticipate potential problems • Helps in writing final report because the protocol forms the basis of the report n.b.: essential for research with humans Algonquin College - Jan Ladas

23. Descriptive Epidemiology Asks several basic questions: • “What” is the disease or health outcome under study? • “Who” is getting the disease? (Young, old, male, female) • “Where” is the disease occurring? (In Canada, urban / rural areas) • “When” is the disease occurring? (During tooth formation, all the time) Algonquin College - Jan Ladas

24. Descriptive Epidemiology • Incorporates incidence, prevalence, rates. • “States a case definition” which: • Generates a hypothesis to be further tested regarding causation and prevention. • Involves – description, documentation, analysis, and interpretation of data to evaluate a current event or situation. • Surveys, questionnaires, indexes. • No interventions done. Algonquin College - Jan Ladas

25. Analytic Research (Correlational) • Studies/surveys in which data collection and analysis are designed to answer a particular question • Seek out cause and effect E.G.: Clinical trial to test reduction of caries by weekly fluoride mouth rinse Algonquin College - Jan Ladas

26. Study Designs (Hypothesis – Testing) • Cross sectional: study of a condition in a group at one point in time (non-experimental) • Longitudinal: study of a condition in a group two or more times • Retrospective: (historical) study the outcome of interest and then probe back for exposure information • Prospective: study information on exposure of interest and compare eventual outcomes Algonquin College - Jan Ladas

27. Experimental Research • Used when cause of disease is established and researcher wants to study the effect of an intervention or experiment in relation to that disease E.G.: A new drug treatment or sealants for 7-12 year olds Algonquin College - Jan Ladas

28. Canadian Health Care System Dental Programs – Federal Government: • In hospital surgical – dental procedures • Cleft Lip and Palate Program • Ontario Works Program (block funding to provinces) • Adults – Emergency treatment only • Children to Age 18 – more comprehensive • Separate Dental Coverage: (3 populations) • Armed Forces, War Veterans and R.C.M.P. • Inmates of federal correction institutions • Native Indian and Inuit persons (MSB) Algonquin College - Jan Ladas

29. Canadian Health Care System Provincial Government (Ontario Ministry of Health) • 41 health units in Ontario • Develops and publishes Mandatory Core Programs • Funds provision of programs Algonquin College - Jan Ladas

30. Canadian Health Care System School Dental Health Services Dental Indices Survey (DIS): • Annual surveillance program of all 5–14 yr. old students Children In Need of Treatment (CINOT): • School screening referral and follow-ups • Clinical preventive services • Family oral health education Dental Health Education (Dental Health Programs Resource Officer): • Provides training and resources for targeted groups • Multiple strategies approach Algonquin College - Jan Ladas

31. Canadian Health Care System Municipal Government Public Health Services • Through the Board of Health (Regional Health Committee) • Organizes broad-based public health services in response to local needs • Environmental services • School health services • Preventive programs • Delivers Mandatory Core Programs • Dental programs – CINOT and DIS • Funds service providers • Dr.’s, PHN’s, DH’s and nutritionists • Support staff Algonquin College - Jan Ladas

32. Why Read Research Articles To provide: • Up-to-date scientifically sound information • The “best” client care in role of clinician, educator, manager,advocator and researcher • Cost-effective practices To understand: • Consumer perspectives / involvement • New technologies n.b.: professional development standards require practice to be research or evidence-based when possible Algonquin College - Jan Ladas

33. My Expectations Students will: • Appreciate and understand what Community Dental Health involves • Attend classes regularly and participate in discussions • Will communicate openly if there are problems and provide feedback • All attain high passing grades Algonquin College - Jan Ladas

34. Student’s Expectations • Information provided is easily accessible I.E. Blackboard, binder in clinic • Focus on pertinent information • Take up assignments in class Algonquin College - Jan Ladas