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Basic Screening Survey
- was developed by the Association of State and Territorial Dental Directors (ASTDD) in 1999
- Systematic method to collect oral health data for preschool, school age, adults, and seniors
- To obtain regional estimates of oral health status in children and compare them to statewide and national data
- Children in Grades Kinder, 2nd and 3rd grades
- Compliance with Healthy People 2030 guidelines for sealant prevalence in the nation
epidemiologyThe study of the determinants and distribution of a health-related condition or disease in a population.oral epidemiologyStudy of the determinants and distribution of dental disease and conditions in the populationcauseAn event, condition, characteristic that precedes a 'disease event' and without which the disease event would not have occurred, or would have occurred at a later timeassociationStatistical relationship between two or more events, characteristics, or other variables.observed associationWhen making associations, proceed with cautioncasual associationAssociation between two categories of events in which change in the frequency or quality of one event is followed by the alteration of the other.agent factorsBiologic or mechanical means causing diseasehost factorsPersonal susceptibility or resistance to diseaseenvironmental factorsPhysical, sociocultural, socio political and economic influencesmandala of healtha model of the human ecosystem in a circular pattern that symbolizes symmetry and wholeness. The confluent circles represent the Determinants of Health.Multicasual TheoryEpidemiology is based on a multifactorial perspective of oral diseases, with consideration given to the interacting relationships among: - Host factors - Agent factors - Environmental factorsprimary servicesprevention services Fluoride, dental sealants, oral health education.secondary servicesservices include fillings, extractions, etctertiary servicesextensive treatment, crowns, partials, implants, oral surgeryevaluationevaluate the selected interventions based on the objectives and use the information to improve the programDMFT/SDecayed, Missing, Filled Teeth/SurfacesRCIroot caries index Assess caries on exposed rootsdef, df, dmftDecayed extracted missing filled primary teethPIPlaque Index Assess plaque ThicknessOHIoral hygiene index Assess Plaque & CalculusOHI-SSimplified version of OHI, selected teeth usedPHPPatient Hygiene Performance Assess plaque and debrisGIgingival index Assess severity gingivitis-swelling, color and bleedingSBISulcus Bleeding Index Assess bleeding sites with probeMGIModified Gingival Index assess gingival inflammation with no probePeriodontal Index-"Ramfjord teeth"Assess specific teeth assigned for periodontal conditionsPDIPeriodontal Disease Index Assess gingival changes and clinical attachment lossCPIcommunity periodontal index Periodontal status of a community with WHO probeNOHSSNational Oral Health Surveillance System Designed to help public health programs on a state and national level monitor: - Burden of oral disease - Use of the oral health care delivery system - Community water fluoridation statusBRFSSBehavioral Risk Factor Surveillance System a state-specific telephone survey conducted with individuals and parents to assess their practice of behaviors that influence health status, including the use of health services.NHANESNational Health and Nutrition Examination Survey program of studies designed to provide a comprehensive assessment of the health and nutritional status of adults and children in the U.S.NHISNational Health Interview Survey monitors health status and access to care in the population with personal household interviews on a broad range of health topicsHealthy PeopleA comprehensive set of national health objectives for the decade Designed to measure progress over time Built on the current scientific knowledge Important part of a national action planAPIEA: assess: Identify the primary health issues P: plan: Develop a measurable process and outcome objectives to assess progress in addressing health issues. Select and plan effective health interventions to help achieve the objectives. I: implement: Implement selected health interventions E: Evaluate the selected interventions based on the objectives and use the information to improve the programPublic Health Solution1. Not hazardous to life or function 2. Effective in reducing or preventing the targeted disease or condition 3. Easily and efficiently implemented 4. Potency maintained for a substantial time period 5. Attainable regardless of socioeconomic status 6. Effective immediately upon application 7. Inexpensive and within the means of the communityexample of a dental public health solutionCommunity water fluoridationName the main government agencies and its branches.Department of Health and Human Services (DHHS) >>Administration for Community living (ACL) >>Administration for Children and Families (ACF) >>Centers for Medicare and Medicaid Services (CMM) >>Public Health ServiceCode 2 (Urgent)Urgent need for dental care Signs and symptoms include pain, infection or swelling Needs dental care within 24 hoursReport the following PH Core functionsASSESSMENT - monitor health - diagnose and investigate POLICY DEVELOPMENT - inform, educate, and empower - mobilize community partnerships - develop policies ASSURANCE - enforce laws - link to/provide care - assure competent workforceProfessional Roles of the Dental Hygienist• Clinician-provides clinical services to target population. Example: public health clinics- federal or state clinics • Educator-faculty role, health education role, networking opportunities, teach community, coordinate service programs • Advocate-sees problems and attempts to develop solutions. Example: legislation and policy changes, serve on committees, be a delegate for SADHA or ADHA • Researcher-uses scientific methods to pursue interest. Example: private, state or University- clinical researcher, product development, • Administrator/Manager-plans or manages community programs federal, state, city programs4 Key Components of dental services at HS:Assessment Accessing Care Prevention EducationHS Funding related to dental treatment? 4 Partner Agencies•AVANCE Head Start •City of San Antonio>Head Start/Early Head Start •Family Service Association>Head Start/Early Head Start •Parent Child Incorporated >Head Start/Early Head StartWho funds HS?HHS- CDC, HRSA, FDA, NIH , CMMS - The Centers for Medicare & Medicaid ServicesDescribe the three types of Epidemiological surveys.Descriptive: Describing general characteristics of the distribution of disease, related to person, place, time - Cross-Sectional Studies - Ex: Basic Screening Survey (BSS) Observational: Observation of the natural course of events noting who is exposed and non-exposed and who experiences the outcome of interest - Case Control Studies - Cohort Studies Interventional or experimental: Investigator allocates the exposure and then follows subjects to desired outcome - Clinical TrialAccess issues and barriers to oral health careChallenges to Accessing Dental Care: •Lack of financial resources •Lack of education (health literacy) •Un-insured or under-insured •Lack of participating dental providers •Parent adherence •Transportation • Limited time and staff to ensure adherenceHead Start program specialist, directors, staff, and parents report the # 1 issue affecting Head Start programs nationwidelack of access to oral health servicesWhat is essential to oral health education programs that have a screening component?Referral and follow up is essentialFee-For-ServiceMost common in US A fee schedule is developed for all services provided by the dental provider Set fees referred to as usual and customary (UCR) Provider submits request for reimbursement Can have discounted fee programs Increases production in officeCapitationDental provider contracts with a program to provide all or most dental services to subscribers in return for payment on a per capita basis. Fee is fixed monthly payment from a third party. Decreases production- no incentive to provide treatment for provider.Encounter RateFee paid based on office visit and not service provided. Rate paid is the same for every visit. Decrease productivity and comprehensive care by clinic. Frequently less services per visit are provided.FQHCFederally Qualified Health Centers community health center designated by the federal government by adhering to regulations pertaining to the scope and quality of health services provided to anyone, regardless of ability to pay An FQHC Look-Alike is a health center identified by the HRSA and certified by the Centers for Medicare and Medicaid Services (CMS) as meeting the definition of "health center," although it does not receive grant funding from the federal government.ACFIncludes administration of the Head Start program, which serves approximately 900,000 preschool children annually Provision of oral health services to individuals who fall outside eligibility guidelines for entitlement programs such as Medicaid are often addressed through voucher or fee-for-service programs. Many of the fee-for-service programs provide for emergency health services for school-age children. Providers are encouraged to try to meet all of the oral health needs of patients within the guidelines of the program.WICWomen, Infants, and Children's Provides grants for supplement foods, health care referrals, and nutritional education for low-income pregnant, breast-feeding, and non-breast-feeding women in addition to infants and children found to be at nutritional risk WIC operates in clinics in all states through local agencies.EPSDTEarly and Periodic Screening, Diagnosis, and Treatment Legislation which authorized the EPSDT Program-Omnibus Budget Reconciliation Act of 1989 Child health program for children under 21 Requires any medically necessary healthcare service be provided to an EPSDT recipient which includes dental servicesOptimal level of fluoride0.7 mg ppmCross-Sectional StudyExamines a group of subjects at a point in time to see if they have the disease Presence of exposure & disease are measured at same point in time Can be used to describe a specific disease in a population (% diseased) By design, cannot be used to establish cause Example: You want to know how oral hygiene knowledge differs across the San Antonio area. Risk factor = residing in urban areas of San Antonio Condition = poor level of oral hygiene knowledgeCase-Control StudyRetrospective study where subjects are classified based upon some outcome (a disease or condition) Cases: Group with the outcome Control: Group without the outcome Looks back in time to see if an exposure/risk factor was more frequent in the case group than in the control group Systematically affected by confounding and bias Example: You want to know if children residing in areas with fluoridated water have a lower risk of developing Severe Early Childhood Caries (SECC) Risk factor = exposure to fluoridated water Outcome = SECCCohort StudyProspective design where subjects are identified based on presence/absence of an exposure and followed to a defined endpoint Can be expensive and time consuming Affected by bias since subjects are not randomized Famous example: Framingham Heart Study Example: You want to know if periodontal disease is a risk factor for cancer in post-menopausal women (the cohort) Risk factor = periodontal disease Outcome = invasive cancerClinical TrialUses randomization of subjects in the study Best study design Can be expensive and take a lot of time Routinely used to test the effect of an exposure to an outcome Effect of a drug on a disease Effect of an educational program on caries prevention Randomization reduces the effect of bias Use of a "control" group (such as a placebo) allows clinical trials to show cause-and-effect Example: You want to know if xylitol chewing gum reduces salivary counts of S. mutans better than regular gumPrevalenceProportion (%) of a population who has the disease at a specific point in time Provides an estimate of the risk that an individual will have the disease at a given point in time Memory helper: Prevalence - Point in timeIncidenceThe rate of instances or new cases of a disease that develops in a population of individuals at risk during a specific time interval Memory helper: Incidence - Interval of timeIdentify the determinants of health that affect the health of individuals and communities.Determinants of health include personal, social, economic, cultural, environmental factors that impact the health status of individuals and populations Biology and genetics Behavior Culture (language, practices, attitudes) Environment (physical, social) Access to care Rather than a single cause for oral disease, consider a multifactorial or multicausal approach