declining
Results show that in general the national caries rates are...
45%
Children and adolescents remain the most vulnerable with what % of them still having caries experience
10%
What % of adults care completely edentulous
30%
What % of people ages 25-34 have moderate attachment loss
33%
22%
Only ____% admit to flossing daily but only ____ % do it efficiently
health behavior
an action that helps prevent disease and promotes health for the individual or population.
�Flossing
�Brushing
�Routine care
A health behavior includes what 3 things?
health behaviors
During our home care instruction we are encouraging our patients to adopt....
�Learning factual information
�Providing motivation
�Getting final outcome: Behavior Change
What are the goals of health education?
health education
instructions regarding health behaviors that bring an individual to a state of health awareness
health interventions
The prevention of disease is done by using appropriate....
true
T/F: healthy education is in transition
learned
behavior is not transmitted, it is...
BOTH TRUE
T/F: learning requires participation on the part of the learner
T/F: this is why most mass education is focused on children
spread effect" or "ripple effect
School based programs can cause the _______ or ________ that spread to home environment.
participant
when performing health education, the primary goal is only motivating the....
�Teaching a population a flossing techniques
�OHI
�Goals of health Education
Instruction regarding health behaviors that bring an individual to a state of health awareness include
health promotion
The science and art of helping people and society change their lifestyles to attain optimal health.
toothbrush, health fair
health promotion occurs when a hygienists gives out a _________ at a __________
health promotion
Ideally the learner gains accurate knowledge about healthy behaviors and lifestyles
health promotion
It is a process that informs and motivates people to adopt healthy behaviors that will enhance their health and prevent disease
health promotion
Similar to health education but is generated more in motivating people to adopt health behaviors
False (it does not necessarily lead to change)
T/F: Knowledge alone leads to change however it is a generous tool for motivation
1.Dental Caries
2.Diseases of the supporting structures
3.Oral pharyngeal cancers
4.Craniofacial injuries
Oral health promotion is aimed at four preventable oral diseases: what are they?
quantity of life
Refers to the number of years an individual lives
quality of life
�How meaningful a given life is
�Dependent on an individuals overall health
TRUE
FALSE (QUALITY)
T/F: Evolution of health care delivery is about preventing the disease increasing the quantity and quality of life.
T/F: Where as previously it would be strictly about quantity
EVOLUTION OF HEALTH EDUCATION/PROMOTION
This is bringing hygiene to the front lines as more research continues to point to a connection to oral health
�Oral cavity is the portal of entry to the body
�Site of millions of bacteria
�The function of the oral cavity is impacted by medications and treatments
�Oral infections increase the morbidity rate for immunocompromised and hospitalized individuals.
�Diab
EXAMPLES OF ORAL HEALTHSEXPANDING IMPACT WHAT? (8)
�Water fluoridation
�Oral self-care behavior
�Oral screening and risk factors for oral cancer
�Early childhood caries
�Oral health effects of anorexia nervosa and bulimia
�Oral health effects of HIV and AIDS
�Cultural issues
�Oral health education for old
MULTIFACTORIAL APPROACH TO ORAL HEALTH PROMO (13)
BOTH TRUE
T/F: There is very little research about how to best promote oral health
T/F: There is a need for more research about attitude and beliefs I oral health and how they can lead to oral health changes.
social factors
Health promoters need to influence...
FALSE (SHORT TERM)
TRUE
T/F: Most behavioral changes that occur after the education or promotion is long term without periodic reinforcement.
T/F: Despite the lack of evidence on the effectiveness of oral health ed and promotion we must ethically disseminate scientific knowledge
BOTH TRUE
T/F: Hygienist have tons of opportunity to become involved in community health activities
T/F: Contribute to the development of a better understanding and improve oral health efforts
oral disease
Customs, values, social networks and ethnicity are all associated with
Micro level
Meso level
Macro level
Social factors can operate on many levels... what are they?
micro level
Individual
Age, gender, SES, Ethnicity, race
what kind of level?
meso level
�Institutional
�Family, groups
what kind of level?
macro level
�Agencies
�medicaid
what kind of level?
Educational
_____________ theories are a set of concepts, definitions and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain and predict events or situations.
BOTH TRUE
T/F: Theories help us to analyze these situations and to apply solutions that have been effective in similar circumstances
T/F: Traditionally we view oral health problems as a patients problem, however the delivery of education does not assess or validate
conceptual framework or models
education and promotional theories is sometimes referred to as....
Theories
Behaviors that lead to improved oral health can be affected by different...
�Individual theories
�Community theories
What are examples of the 2 theories?
FALSE ( IS NOT)
T/F: there IS a single theory that applies to ALL situations
communication
what kind of skills are critical to effective implementation?
TRUE
T/F: The health literacy of the target population must be considered for successful outcomes
TRUE
T/F: THEORIES CAN BE COMBINED TO MEET THE NEEDS OF THE SITUTATION
cultural sensitivity
All theories must demonstrate ___________ ___________ to meet needs of population
TRANSTHEORETICAL MODEL
stages of change = what theory?
TRANSTHEORETICAL MODEL
Understanding the increments in which a person actually learns information is important.
process or cycle
�Views change as a ______ or _______ that occurs over time rather than as a single event in the TRANSTHEORETICAL MODEL theory
TRANSTHEORETICAL MODEL
�The learning ladder depicts progression from knowledge absorption to value adoption
TRANSTHEORETICAL MODEL Key points
�State of readiness is required to change
�Follows step-by-step orderly process of change though predictable stages
TRANSTHEORETICAL MODEL Limitations
�Behavior change is not linear
�Research shows more success in immediate change than long term change
FALSE (IS NOT)
T/F: behavior change IS linear
assessing ones state or readiness
-tobacco cessation
EXAMPLES of TRANSTHEORETICAL MODEL is....
behavior and intention
THEORY OF REASONED ACTION focuses on the belief that people make rational decisions based on a _______ and _______
THEORY OF REASONED ACTION
�a combination of a person's attitude and is therefore the most immediate and relevant predictor that the person will take action.
knowledge, values and attitudes
(Theory of reasoned Action Key points)
People make rational decisions based on 3 things... what are they?
BOTH TRUE
(Theory of reasoned Action Key points)
T/F: Person's intent to change is strongest predictor of action
T/F: Intentions and behavior are addicted by personal behavioral beliefs and norms.
FALSE (DOES NOT deal)
T/F: Theory of reasoned Action deals with FACTUAL information
TRUE
T/F: Theory of reasoned Action focuses ONLY on the emotional aspects and motivation of behavior
self efficacy
�The belief that one's actions will have an impact on a desired outcome
SOCIAL COGNITIVE THEORY is also known as...
SOCIAL COGNITIVE THEORY
�Assumes that knowledge, behavior and environment act in a reciprocal manner to continually affect each other
SOCIAL COGNITIVE THEORY
The belief that one's actions will have an impact on a desired outcome
�Direct exposure (It happened to you)
�Vicarious experience ("Someone I know")
�Judgement voiced by others (Promotions by speakers)
�Inferred knowledge (Implied or learned first hand)
SOCIAL COGNITIVE THEORY States that learning happens in four ways: list them
Direct exposure
It happened to you
Vicarious experience
Someone I know
Judgement voiced by others
Promotions by speakers
Inferred Knowledge
Implied or learned first hand
SOCIAL COGNITIVE key points
acquired through enactive attainment, verbal persuasion, observational learning, behavioral capability, and reinforcements
SOCIAL COGNITIVE key points
�Knowledge, behavior and environment act in a reciprocal manner to continually affect each other and increase self control over actions
SOCIAL COGNITIVE key points
Belief that personal actions affect outcomes
Predicts health status
SOCIAL COGNITIVE Application
�Using small successes to motivate behavior change
�Counseling that failure is part of the learning process
�Using credible role models to tie learning to someone else's experience
�Provides ongoing counseling
�Reinforcing behaviors
�Encouraging self-init
SOCIAL COGNITIVE Application
�Sloppy
�Not step by step
�Self-efficacy varies for different health conditions
LOCUS OF CONTROL
Perception of personal control over health status
I can control this
Internal LOC says...
Its your fault
External LOC says...
True
T/F: One's LOC tends to relate to all health issues
Locus of Control Limitations
Perceptions can be deeply ingrained and emotionally driven
Locus of Control
Counseling that focuses on individuals personal power over health decisions and health status
SENSE OF COHERENCE
SENSE OF COHERENCE
�Individuals that have a strong network of resources will develop and overall ____________ ___________ ______________ that can be used in any situation to deal with various stressors
BOTH TRUE
T/F: Individuals with this SOC find problems manageable, comprehensible, and meaningful
T/F: They have sufficient resources to handle the situation and the means to use those resources and manage stressors
SENSE OF COHERENCE Key points
�The extent to which one has confidence that one's environment is predictable and that things will work out as well as possible
�Application to health is based on concept that disease is a continuum
SENSE OF COHERENCE Key points
�Stressors and tensions move one along the continuum toward disease
�Individuals develop resources to reduce or manage stressors to move along the continuum to health
with better oral health
�Higher SOC is associated....
SENSE OF COHERENCE Limitations
Does not include a focus on expanding knowledge of factual oral health information
COMMUNITY ORGANIZATION
�Process of involving and activating members of a community or subgroup to:
�Identify a common problem or goal
�To mobilize resources
�To implement strategies
�Evaluate the efforts
COMMUNITY ORGANIZATION key points
�Represents several theories that describe how community groups are assisted in identifying common problems or goals
�Accomplished through empowerment, community competence, participation and relevance, issue selection and critical consciousness
COMMUNITY ORGANIZATION
On a small scale:
Helping a school or other community group improceoral health of its members
COMMUNITY ORGANIZATION Limitations
�Requires time and effort to identify key influences and involve the members of the community in the assessment, planning and implementation process
DIFFUSION OF INNOVATION
Addresses how new ideas, products, practices and services spread within a society
DIFFUSION OF INNOVATION
Adoption of sealants, fluoride varnish, CAMBRA are examples of...
DIFFUSION OF INNOVATION Limitations
Requires a complex and comprehensive approach
ORGANIZATIONAL CHANGE THEORY�
Organizational pass through a series of four stages as they initiate change
�Definition of a problem
�Initiation of action
�Implementation of change
�Institutionalization of change
ORGANIZATIONAL CHANGE THEORY Key Points
�A wide variety of forces make an organization resistant to change
�Including how it operates, its structure, culture and control systems
�A wide variety of forces also push an organization toward change
�These include changing of tasks, and the environme
ORGANIZATIONAL CHANGE THEORY Limitations
ORGANIZATIONAL CHANGE THEORY Limitations�Theory relates to the infrastructure of community oral health practice, not to health promotion
�Requires a complex and comprehensive approach
�Requires time and effort to change an organization
ORGANIZATIONAL CHANGE THEORY
Reorganizing the structure of the health system in the nation
Reorganizing a community based clinic to meet the needs of a the population it serves
These are Examples of...
Framing
Relates to the cues (sounds, symbols, words and pictures) that signal how and what to think about an issue�In the process of framing messages an attempt is made to connect to people's values, beliefs knowledge level and emotions
framing
�In the process of framing messages an attempt is made to connect to people's values, beliefs knowledge level and emotions
Tailoring
Relates to the cutes being used to make messages meaningful for a specific individual
tailoring
what is the MOST EFFECTIVE health communication
Generic
�Messages that cover a large number of concepts trying to appeal to the greatest number of people
Generic
which health communication is NOT very effective and is great for large populations
Targeted
Which health communication: �Intended to reach a specific subgroup
�Very Effective
�Tactile
�Auditory
�Visual
LEARNING STYLES list 3
PROFESSIONAL PRESENTATIONS
The purpose of professional presentations is to deliver though-provoking information to a group of health professionals in a short period of time in a clean concise and visually appealing way
DENTIST
a person who is permitted to practice under the laws of a specific location
Dental auxiliaries
A generic term for persons who assist the dentist in treating patients.
True
T/F: Auxiliaries can be classified into operating and non operating depending on if they carry out procedures in direct patient care.
Operating and Non-operating
Dental auxiliaires can be these two things depending on procedures in direct patient care:
HYGIENISTS
ASSISTANTS
EFDA
Operating dental auxiliary
LAB TECHS
RECEPTIONIST
SECRETARY/MANAGER
Non-operating dental auxiliary
Recent national reports discuss a maldistribution of dentist and how it impacts the oral health needs of the nation.
Even with adequate number of providers how they are distributed remains an issue.
Geographic maldistribution of dental providers contribut
DISTRIBUTION OF DENTAL PROFESSIONALS
False (Urban)
T/F: Majority of dentists are located in rural areas
True
T/F: Counting dental professionals is not as easy as it may appear. Membership lists from organizations and licensing lists are most commonly sourced but are rarely accurate.
some professionals maintain membership even when they are retired or otherwise not engaged professionallyprofessional
Some are not members of a professional organization
Dentists can hold a license in more than one jurisdiction
Work in a non-clinical sett
Why is counting dental professionals inaccurate?
(Health Professional Shortage Area)
What does HPSA stand for?
Was made by HRSA.
A geographic area does not meet the shortage criteria but a population group within the area has access barriers a population group designation may be possible.
Public and non-profit faculties located outside the designated area may rece
Dental HPSA
False (1 to 5,000)
T/F: HPSA are based on a dental ration of 9000:1
True
T/F: Parts of rural Pennsylvania experience a 9000:1 ratio.
True
T/F: As of 2019 there are over 100 HPSA locations in PA
Hawaii
New York
Massachusetts
New Jersey
Connecticut
Favorable locations
Alabama
North Carolina
Arkansas
Mississippi
Nevada
Least favorable
Relative freedom for dentists in choosing practice location
Location of dental schools
Market response
Possible reasons for this distribution:
Expand the dental health aide therapist model for tribal lands
Increase grants and contacts for provider education
Increase funds for loan repayment
Create new primary care residency programs
Increase funds for community health centers
Solutions for shortages
The early development of specialists was informal and did not require certification.
As specialties became popular examining boards and certified specialties came into being
CODA acknowledges 9 dental specialties
most of these require a dental license wit
Dental specialists
Dental public health
Endodontics
Oral and maxillofacial radiology
Oral and maxillofacial pathology
Oral and maxillofacial surgery
Orthodontics
Pediatrics
Periodontics
Prosthetics
CODA acknowledges 9 dental specialties
False (80%)
T/F: 10% of all dentists are General Practitioners
Expand the dental health aide therapist model
Increase grants and contracts for provider education
Load repayment programs
Create new primary residency programs
New workforce models
Increase funding for community health centers and school based health cen
Shortage solutions
Until the early 1980's only about 3% of dentists were female
In 1998 13% female
As of 2014 48% of all dental students were female
Trends in the workforce
Practice part time
Take extended breaks
Spend fewer hours practicing over a career
Women in the workforce are more likely to:
much slower
1990- 90% white
2014 -15-20% minorities
Trends in the workforce: Diversity is also changing
False (were never present)
T/F: Foreign trained dentists were always present in large numbers, however states are entertaining ways to use this knowledge base to help combat access to care
Decline in the number of dentists
Growth in the number of dental hygienists
Demographic shifts among graduates of dental schools
Changing in oral disease patterns
Barriers to dental care faced by underserved populations
Factors that are expected to impact changes of composition and size of the dental workforce:
True
T/F: For changes of composition and size of the dental workforce, there will be a need for long term care for older adults due to tooth retention.
True
T/F: Culturally competent workforce will be needed due to a growth in minorities in the salad bowl of US
False (greatly effect)
T/F: Dental schools do not really effect supply of dentists.
True
T/F: The government has no direct control over dental education but it can incentivize to increase enrollment numbers.
In the 60's and 70's incentives were given to build new schools and up enrollment.
From 1990 to 2019 the number has stayed relatively flat- 66 as of 2019
The number of hygiene schools has skyrocketed
(Over 100 programs in 20 years, 335 as of 2014)
Dental education on dental supply
True
T/F: It has been suggested that the surplus of DH practioners could be used to fill the gap resulting in the shortage of dentists by expanding care and using the hygienist more effectively in the delivery system
regulate the relationship between a provider and the public.
State practice acts
True
T/F: A state practice act/license prevents/stalls the movement of dentists form one state to another
is the use of informational technology and telecommunication for dental care, consultation, education and public awareness in the same manner as telehealth and telemedicine
Teledentistry
Teledentistry
This approach make sit possible to take oral healthcare services to the underserved communities
This will also increase interprofessional collaboration
California
Colorado
Missouri
�Becoming more popular across the country but big users of Teledentistry are
1. international
2. Federal
3. State
4. local
Governmental role in public health: Four main levels of community dental health include?
Coordinates programs for underdeveloped nations and gathers epidemiological data for comparison across nations
Develops means to summarize treatment needs of international populations utilizing minimal equipment
Government DPH- International
WHO
Government DPH- International example
Acts on oral health problems of national significance
Primarily via the department of Health and Human Services
Healthy people
They provide infrastructure, research surveillance and funding for programs that are carried out at the state and local areas
Government DPH- Federal
Primarily via the department of Health and Human Services
CDC,HRSA, NIH, NIDCR
Healthy people
Government DPH- Federal Examples
Provides consultation services to local health departments
Directly administers some programs that are done on a state basis
Government DPH- State
Directly administers county and city programs
Initiates dental health legislative measures such as fluoridation
Government DPH- Local
PHS (PUBLIC HEALTH SERVICE)
The _____ is one of four major agencies within the DHHS.
one of four major agencies within the DHHS.
Promotes health standards, ensures highest level of healthcare is available for all
Cooperates with other nations on health projects
Public Health Service (PHS)
CENTERS FOR DISEASE CONTROL AND PREVENTION
HEALTH RESOURCE AND SERVICE ADMINSTRATION
NATIONAL INSTITUTE OF HEALTH/ NIDCR
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY
FOUR AGENCIES UNDER THE PHS
True
T/F: For Use and Prevention, Preventive measures need to be adopted and applied by communities, individuals and professionals to ensure marked improvements of the Nation's oral health
Need, Demand, Supply, Utilization, Barriers
Use and prevention includes what 5 things?
A normative professional judgement as to the amount and kind of health care services required to maintain or attain health
Need for Use and Prevention
The type of care desired
Demand for Use and Prevention
Quantity of dental care available
Supply for Use and Prevention
The number of dental services accrual consumed
Actual use
Utilization for Use and Prevention
Obstacles
Barriers for Use and Prevention
Unprecedented changes in demography, patterns of disease and disorders and healthcare finance and delivery; Change sin science and tech; Access to multiple information systems, including internet, computer based tech (telemedicine, distance ed); Improve t
Challenges in the 21st century
�Dental care
�Psychiatric care
�Prescription drugs
�Longtermcare
After WW2 medical insurance was growing rapidly
Dental insurance as not
Considered one of the "Fearful four"
What were the four?
�Be precisely definable
�Of sufficient magnitude that if it occurs it constitutes a major loss
�Infrequent
�Of an unwanted nature- such as a fire
�Beyond the control of the individual
�Without moral hazard- the presence of insurance itself should not lead
Historical-dental care: Dental needs violated the basic principles of insurance which stated that to be insurable a risk must
�Having patients pay a share of the costs
�Limiting the services available
�Offering coverage only to groups
�Including waiting periods after enrollment
�Using preauthorization and annual expenditure limits
Historical-dental care: Insurance benefits were meant to be paid out in relatively small amounts. Insurance carriers found that they could get around these problems by:
�Having patients pay part of the cost is an economic disincentive to over utilization
�The portion of the cost of the service that the patient pays is either Deductible or Co-payment
Insurance-historical and today
A set amount of money that the patient must pay towards the cost of treatment before benefits go into effect
Deductable
�A portion of the cost of each service that is paid by the client.
�Flat amount
�Remainder of the payment is covered by the third-part
Co-payment
�means that the patient pays a percentage go the total cost of treatment-
�20% of orthocosts
Co-insurance
Insurance plan will only pay up to a specific dollar limit each year
Annual limits
Oatuebtmust wait a specified length of time before coverage beings
Waiting Period