Dental public health
Dental public health is a para-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effective solutions to improve the dental health of populations rather than individuals.
Dental public health seeks to reduce demand on health care systems by redirection of resources to priority areas. Countries around the world all face similar issues in relation to dental disease. Implementation of policies and principles varies due to availability of resources. Similar to public health, an understanding of the many factors that influence health will assist the implementation of effective strategies.
Dental-related diseases are largely preventable. Public health dentistry is often practiced through government-sponsored programs, usually directed to public-school children, following the premise that early education about oral hygiene is the best way to reach the general public. For example, a dental practitioner's annual visit to a local school to demonstrate proper tooth-brushing techniques.
In the 1970s, a more elaborate program emerged. It included a week of one-hour sessions of instruction, demonstration, and questions and answers, conducted by a dentist with a dental assistant and aided by a teacher who had previously been given several hours of instruction. Use was also made of televised dental health education programs, which parents were encouraged to observe.
Background
Even with fluoridation and oral hygiene, tooth decay is still the most common diet–related disease affecting many people. Tooth decay has the economic impact of heart disease, obesity and diabetes.Risk factors for tooth decay include physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty.
Cavities can develop on any surface of a tooth, but are most common inside the pits and fissures in grooves on chewing surfaces. This is where the toothbrush bristles and fluoride toothpaste cannot reach effectively.
Gum diseases gingivitis and periodontitis are caused by certain types of bacteria that accumulate in remaining dental plaque. The extent of gum disease depends on host susceptibility.
Daily brushing must include brushing of both the teeth and gums. Effective brushing itself, will prevent progression of both tooth decay and gum diseases. Neutralising acids after eating and at least twice a day brushing with fluoridated toothpaste will assist preventing dental decay. Stimulating saliva flow assists in the remineralisation process of teeth, this can be done by chewing sugar free gum. Using an interdental device once daily will assist prevention of gum diseases.
Fissure sealants applied over the chewing surfaces of teeth, block plaque from being trapped inside pits and fissures. The sealants make brushing more effective and prevent acid demineralisation and tooth decay. A diet low in fermentable carbohydrates will reduce the buildup of plaque on teeth.
Practice
Competencies
The American Board of Dental Public Health devised a list of competencies for dental public health specialists to follow. Dental public health specialists are a select group of certified dentists. The ten competencies allow for growth and learning of individuals and set expectations for the future. An advantage of the design is that they are implementable on a global level. The list is updated periodically.| 1998 competencies | 2016 competencies |
| 1. Plan oral health programs for populations | 1. Manage oral health programs for population health |
| 2. Select interventions and strategies for the prevention and control of oral diseases and promotion of oral health | 2. Demonstrate ethical decision-making in the practice of dental public health |
| 3. Develop resources, implement and manage oral health programs for populations | 3. Evaluate systems of care that impact oral health |
| 4. Incorporate ethical standards in oral health programs and activities | 4. Design surveillance systems to measure oral health status and its determinants |
| 5. Evaluate and monitor dental care delivery systems | 5. Communicate on oral and public health issues |
| 6. Design and understand the use of surveillance systems to monitor oral health | 6. Lead collaborations on oral and public health issues |
| 7. Communicate and collaborate with groups and individuals on oral health issues | 7. Advocate for public health policy, legislation, and regulations to protect and promote the public's oral health, and overall health |
| 8. Advocate for public health policy, legislation, and regulations to protect and promote the public's oral health, and overall health | 8. Critically appraise evidence to address oral health issues for individuals and populations |
| 9. Critique and synthesize scientific literature | 9. Conduct research to address oral and public health problems |
| 10. Design and conduct population-based studies to answer oral and public health questions | 10. Integrate the social determinants of health into dental health practice |
Scope
Major areas of dental public health activity include:- Oral health surveillance
- Assessing the evidence on oral health and dental interventions, programmes, and services
- Policy and strategy development and implementation
- Oral health improvement
- Health and public protection
- Developing and monitoring quality dental services
- Dental public health intelligence
- Academic dental public health
- Role within health services
Principles and criteria
To allow a health problem to be properly managed, a set of rules or criteria may determine what is defined as a public health problem and what is the best way to manage health problems in communities. Once these questions have been answered, the way a public health problem is acted upon to protect a population can be determined.
Approaches to prevention
Fluoridation of drinking water
is the implementation of artificial fluoride in public water supplies with the intentions to halt the progression of dental diseases. Fluoride has the ability to interfere with the demineralisation and remineralisation process that occurs on the tooth surface and improves the mineral intake when the pH level may reduce below the neutral pH level.This achievement was implemented through the public health development in the 19th, 20th century and led into the 21st century. Research into the effects of fluoride on teeth began due to the concern about the presence of dental fluorosis.
Many clinical case trials occurred in the beginning of the 20th century. However, the very first clinical trial to have occurred dates back to the 19th century when Denninger conducted a trial prescribing children and pregnant women with calcium fluoride. From this trial, it was recognised fluoride's significance on tooth tissue. From this point, many clinical trials were conducted Following these studies, the recognition of the positive outcome on dental tissues became clear and projects in water fluoridation became of significant importance.
The development of artificial water fluoridation began in 1945 in Grand Rapids, Michigan followed by Newburgh, New York and Evanston, Illinois. In 1955, three towns Watford, Kilmarnock and Anglesey trialled the water fluoridation implementation scheme. In 1960, the Republic of Ireland implemented all public water supplies with artificial fluoridated water and four years later extending this into the main cities of Dublin and Cork.
40 countries have fluoridated water schemes implemented. Fluoride is still yet to be completely implemented across the full population. Progress is slowly improving and access is becoming more common.
| Country | Population with fluoridated water |
| Argentina | 21% |
| Australia | 61% |
| Brazil | 41% |
| Canada | 43% |
| Chile | 40% |
| Columbia | 80% |
| Hong Kong | 100% |
| Israel | 75% |
| Malaysia | 70% |
| New Zealand | 61% |
| Panama | 18% |
| Republic of Ireland | 73% |
| Singapore | 100% |
| Spain | 10% |
| United Kingdom | 10% |
| United States | 74.4% |
Career
Prevention methods such as oral health promotion began with the education of clinicians and the population in the health promotion strategies. Since the mid 19th century, oral health practice has revolved more around prevention and education rather than treatment of disease. This education can be focused towards dental practitioners and to the wider population who may interested.There has been a change in focus in the education of developing clinicians all over the world. The first dental school was developed in 1828 and was followed by an ever-growing field of practice. The dental practice began with its main focus on the treatment of oral disease and branched into a wide scope of practice with many dental occupations involved.
The most common form of dental clinicians are either general dentists, oral health therapists, dental therapists and dental hygienist. When desired, some of these clinicians may seek further experience in projects that may assist the dental public system in bringing further awareness to prevention of dental diseases.
Oral health prevention is the current form of practice of many clinicians. Health professionals generally prefer education in oral care to the population to the treatment of the disease. Dental university education develops clinicians to focus on the education of patients, education of the community and a wider population using different approaches.