-assessment
-diagnosis
-treatment planning
-treatment
-payment
-evaluation
dental practice
-survey
-analysis
-program planning
-program operation
-finance
-evaluation/appraisal
community dental health
focus on health problems of international status
international
which government public health agency is at an international level
World Health Organization (WHO)
focus on health problems of national population
federal
-Department of health and human services (DHHS)
-Center for Disease Control (CDC)
-Health resources and services administration (HRSA)
-national institute of health (NIH)
-national institute of dental and craniofacial research (NIDCR)
-agency for healthca
federal public health agency
focus on health problems of state populations; consult with local health departments
state
focus on health problems of local population
local
provides general understanding for critically interpreting new information in literature
epidemiology
1. collect data to describe normal biological processes
2. understand the natural history of disease
3. measure the distribution of diseases in a population
4. identify the determinants of disease
5. test hypotheses for prevention and control of disease t
uses of epidemiology
a disease that occurs regularly in a population as a matter of course
endemic
an unexpectedly large number of cases of disease in a particular time and place
epidemic
an outbreak of disease over a wide geographical area such as a continent
pandemic
the number of events that occur in a given population in a given period of time
rate
the number of live births
natality
the rate of an illness in a population
morbidity
the number of deaths in a population
mortality
the number of new cases in a population at risk during a particular period of time
-conveys information about the risk of contracting a disease
incidence
the number of new and old cases of a disease in a population in a given period of time
-tells how widespread the disease is
prevalence
an incidence rate calculated for a particular population for a single disease outbreak
attack
-describes an epidemic with respect to person, place, and time
-helps to determine who is getting the disease, where the disease is occurring, and when the disease occurs
descriptive studies
aimed at testing hypotheses
analytical studies
-case-control study
-seeks to compare those diagnosed with a disease with those who do not have the disease
retrospective study
a cohort is classified by exposure to one or more specific risk factors observed into the future to determine the rate at which the disease develops
prospective study
a group is observed over a long period of time
longitudinal study
studies carried out under controlled situations
experimental studies
the group who has the experimental treatment withheld; receive a placebo
control groups
the group that receives the experimental treatment
treatment groups
researcher remains uninformed and unaware of the identities of treatment and control group members to prevent bias
blindness
neither the researcher nor the subjects know who is receiving treatment
double blindness
using indices to express clinical observations in numerical form
measuring oral disease
-simple
-valid
-reliable
-clear
-sensitive
-quantifiable
-objective
-accepted
characteristics of an ideal index
measures conditions that can be reversed or resolved
-gingivitis
reversible
measures cumulative conditions that cannot be reversed
-caries and periodontitis
irreverisible
measures the presence or absence of a condition
simple
measures all the evidence of a condition; past and present
cumulative
-irreversible
-used to measure past and present caries experience in a population with permanent teeth
DMFT/DMFS
what does DMFT stand for
decayed, missing, filled teeth
-irreversible
-measures observable caries experience in primary teeth
-does not take into account teeth that have been extracted or exfoliated due to past caries experience
deft
what does deft stand for
decayed, need for extraction, filled teeth
what does dft stand for
decayed, filled teeth
-irreversible
-attempts to assess the extent of root caries experience within the context of individuals at risk for the disease
RCT (root caries index)
-reversible
-based on severity of inflammation and location
-can be used in individuals or study participant
GI (gingival index)
-reversible
-detects early signs of gingivitis
-used in short term trials
SBI (sulcular bleeding index)
-irreversible
-meausres the prevalence and severity of periodontal disease
-measures both the reversible and irreversible attachment loss of periodontal disease
PDI (Periodontal Disease Index)
-irreversible
-developed by russel
-each tooth is scored according to the condition of surrounding tissue
-does not measure loss of attachment
PI (periodontal index)
-rapidly assesses periodontal health
-requires a special probe
-preliminary screening in large populations
PSR (periodontal screening and recording)
-developed by WHO
-determines periodontal needs versus status
-requires special probe
CPTIN (the community periodontal index of treatment needs)
-reversible
-measures oral hygiene status
-involves both a debris and calculus index
OHI-S (simplified oral hygiene index)
-developed by silness and loe
-reversible
-measures difference in thickness of soft deposits at gingival margin
-used in conjunction with GI
PLI (plaque index)
-reversible
-assesses individuals performance in removing debris after toothbrushing
PHP (patient hygiene performance)
-reversible
-used to test agents for plaque control and calculus inhibition
-scores supragingival calculus following prophylaxis
VMI (Volpe-Manhold index)
-process by which the planner identifies and measures gaps between what is and what ought to be
-analyses and understand the target population
needs assessment
-defines the extent and severity of problem
-identifies causes of problem
-collects baseline data
reasons for needs assessment
-time consuming, not cost effective for large groups
direct observation and interview needs assessments
must be well written and easy to understand
questionnaire needs assessment
best choice for large groups, must be well written
survey needs assessment
research based
epidemiological needs assessment
records, documents, charts
review of documented records needs assessment
-type of care available
-can be seen through the eyes of the planner or the eyes of the target population
need
type of care desired
demand
actual receipt of dental treatment by public
utilization
obstacles which interfere with care to be provided
barriers
complete examination, includes mouth mirror and explorer, lighting, radiographs, study models, tests
type I exam
limited examination including mouth mirror, explorer, lighting, and limited radiographs
type II exam
examination using mouth mirror and lighting only
type III exam
examination with tongue depressor and lighting only
type IV exam
policy development, decision making, leaders, policy makers, attitudes towards oral health by community leaders
collection of preliminary information
health insurance for elderly and disabled
medicare
health insurance for the poor
madicaid
offers insurance to workers where they no longer work
COBRA
lump sum of money given to group to use at their discretion
block grants
specifies where monies are to be used
line item grant
ranks needs of population
establishing priorities
broad based statement of what changes will occur as a result of program
goal
specific statement that can be measured
objective
specific statement that can be measured
objective
-development
-choose activities that have been tested
drafting a plan
review needs of target population
periodic assessment and readjustment
carrying out the lesson plan
implementation
active - lecture, demonstration, discussion
formal delivery
-motivational factors must be present
-learning only progresses as far as the learner wants
-learning proceeds more rapidly when what is being taught has value
principles of learning
-unawareness
-awareness
-self-interest
-involvement
-action
-habit
the learning ladder
learner has incomplete or inaccurate information
unawarness
correct information is obtained but lacks personal meaning
awareness
learner personalizes information
self-interest
old ideas are discarded for new; learner is motivated to act
involvement
learner tests new concepts based on perceived needs
action
learner begins to experience gratification and self-satisfaction
-behavior is modified
habit
must be continuous from the beginning of the program
evaluation
-outcome evaluation
-measures the impact of the program
summative evaluation
conducted during the program
formative evaluation
-allows data to be quantified
-represents mathematics of collection, organization, and interpretation of numeric data
biostatistics
describes
descriptive statistics
generalize about large populations based on small populations
inferential statistics
each element of the population has an equal chance of being selected
-reduces chance of bias
random sample
selecting an element according to certain subgroups
stratified sample
selecting the nth participant
systemic sample
someone familiar with the population selects the sample
-high chance of bias
judgement sample
sample group is chosen based solely on convenience
convenience sample
the outcome of interest; should change in response to intervention
dependent variable
the intervention; what is being manipulated
independent variable
arranges data scores from lowest to highest
data matrix
measures how often each score occurs
frequency of distribution
data is presented in acending or descending order along with the frequency of each score (96=4 87=1)
ungrouped score
grouping variables into consecutive intervals (91-96=7)
grouped scores
frequency of occurence of scores up to and including any given value in the data set
cumulative scores
frequency of distribution is plotted on an x-y graph resulting in a pictorial representation of data
measures of central tendency
-arithmatic average of scores
-most common measure of cental tendency
-sensitive to extreme values
mean
-divides the distribution of scores into two equal parts
-not affected by extreme highs or lows
median
-the most frequently occurring score
-affects the skew of the graph
mode
when the data is plotted using a normal curve the mean median and mode are all
equal
describes how wide the scores are around a central point
measures of dispersion
-the difference between the high and low score of a data matrix
-affected by extremely high or low scores
range
-represent the square root of the sample variance
-most commonly used method of dispersion in oral hygiene research
standard deviation
the bigger the ______ ______ the wider the _______
standard deviation // curve
do you want there to be a large sd or small sd?
small (the more data is spread out the harder it is to come to a conclusion)
in a normal bell curve what percent of scores fall between -1 and +1 standard deviation
68%
when scores are not uniform, the graphed data will demonstrate an asymmetrical appearance and it is said to be what
skewed
when more scores fall in the lower range (tail goes to the right)
positive skew
when more scores fall in the higher range (tail goes to the left)
negative skew
allows one to generalize findings from the sample study to a larger population
inferential statistics
degree that a study measures the variable it is designed to measure
validity
the extent to which the method of measurement performs consistently
reliability
consistent performance by the same examiner
intraexaminer reliability
consistent performance between examiners
interexaminer reliability
ability of a test to correctly identify the presence of a disease
sensitivity
process of establishing a relationship between a measuring device and the units of measure; helps increase interexaminer reliability
calibration
ability of a test to identify the absence of a disease
specificity
determines the strength of a relationship between two variables
-shows probable cause/effect
-the closer the number is to +1 or -1 the stronger the relationship
correlation co-efficient
-direct association between two variables
-as the value of x increases the value of y increase and vice versa
positive correlation
-the score on one scale predicts an opposite score on the other scale
-as the value of x increases the value of y decreases
negative correlation
a statistical hypothesis test used when comparing the statistical difference between two mean scores
t-test
used when comparing the statistical differences between three or more scores
ANOVA
-used when testing hypothesis
-refers to the probability that a condition would happen by chance
-standard of acceptability is 1 out of 20 or a p-value of <.05
p-value
-involves preventive therapies
-techniques are designed to prevent, reverse, or arrest a disease process before treatment becomes necessary
primary prevention
treating or terminating a disease or condition to restore tissues to as normal as possible
secondary prevention
replacing lost tissues in order to rehabilitate patients
tertiary prevention
passive - brochures, pamphlets, etc
informal delivery
specific statement that can be measured
objective