Dr Aasim Masood DEFINITION: “Absence of disease”. WHO defined as “a complete physical mental and social well being and not merely an absence of disease or infirmity”. The art and science of preventing and controlling dental diseases in addition to promoting the dental health through organized community efforts 1.Dental health education to the public. 2.Preventing and controlling of dental diseases. 3.The applied dental researches. 4.Providing dental care programs that include the prevention and treatment. To give better understanding of the patient that should be treated as a part of the community rather than a specific case that needs treatment. To realize the importance of implanting the future dental practice based on the regular maintenance of care and utilization of preventive measures To provide the specialized skills and knowledge that will enhance the future practice dentistry. To identify the community health problems and suggest approaches for their correction assessing, reviewing, and recording a patient’s risk for dental diseases, oral health status and to “prescribing” an appropriate treatment. Clinical practitioner 1.Assessment of dental, medical history and oral health status. 2.Diagnosis of the patient oral health. 3.Treatment plan based on diagnosis and patient needs and priorities. Community dental practice 1.Survey of the commt oral health status and their demographic characters. 2.Analysis of the survey data to determine health needs. 3.Program plan based on the resources available and priorities 4.Payment method is determined. 5.Evaluation during treatment at specific interval 4.Financing takes place. 5.Evaluation of the program progress Dental public health deals with the whole community rather than the individuals so, it called community dentistry. Biomedical concept Ecological concept Psychosocial concept Holistic concept Health has been viewed as “absence of disease”.if person is free from any disease than he is healthy. This found inadequate because of major health problems Malnutrition Chronic disease Accident Equilibrium between man and environment, and disease a maladjustment of the human organism to environment. health is influenced by 1) social 2) psychological 3) cultural 4) economic 5) political Sound Sound Sound Sound mind, body, Family, environment ? Opposite of health . Any deviation from normal or state of complete physical or mental well- being. During 19th and early 20th century emphasis shifted from emperical cause (bad air) to microbes as the sole cause of the disease. Disease Agent Man disease AGENT HOST ENVIROMENT Defined as substance,living or non-living,the excessive presence or relative lack of which may initiate or perpetuate a disease process. Classification: 1) Biological 2) Nutritional 3) Physical 4) Chemical 5) Mechanical 6) Social Defined as a person or other animal,including birds and or arthropods,that affords subsistence or lodgments to an infectious agent under natural condition. Classification Demographic i.e age,sex. biological Such as genitic factors. Social and economic Living conditions (housing, crowding, water supply, refuse, sewage, etc) Atmosphere / climate Pettenkofer (munich) Due to advancement in public health, i.e chemotherapy,antibiotics and vector control, decline in communicable disease. And beginning of new type disease Lung Cancer,coronory heart disease,metal illness. Model of disease suggested by Mac Mohan an suited in d pugh,this model is ideally in chronic disease. Where the agent is not known, but is the outcome of interaction of multiple factors. Prepathogensis phase Pathogensis phase When the disease agent is not firmly established the etiology is generally discussed in terms of risk factor. The risk factor does not mean that the disease will occur ,and its absence it will occur. e.g smoking and occupational exposure(dye and leather) in bladder cancer. On the other hand smoking has an affect on the hypertension and high blood cholesterol. The risk factor may be causative or mrely contributory factor. So some risk factor can be modified like smoking ,alchol,but some (age,sex) cannot be modified . symptomatic disease What the physcian sees ----------------------------------------Presymptomatic what the disease Physcian does m--------------------------not see ------------------------------------------------------------------------------------------------------------------------------------------------------ Figure 6.6 The pyramid and iceberg of disease 1 Diseased, diagnosed & controlled 2 Diagnosed disease Diagnosed, uncontrolled 3 Undiagnosed or wrongly diagnosed disease 4 Risk factors for disease 5 Free of risk factors Undiagnosed or wrongly diagnosed disease Prostate cancer based on cases diagnosed in hospital would lead to the view that the disease is usually, if not always, progressive. Unselected cases show that prostatic cancer can in some cases be a static, or slowly progressive, phenomenon. Patients who are at the tip of the iceberg are more likely to have multiple health problems than others. People with cardio-respiratory problems and diabetes are more likely to be admitted to hospital, than people with only one of these two problems. This is the basis of the bias known as Berkson's bias. Screening is the testing of apparently healthy populations to identify previously undiagnosed diseases or people at high risk of developing a disease. Screening aims to detect early disease before it becomes symptomatic. The choice of disease for which to screen; The nature of the screening test or tests to be used; The availability of a treatment for those found to have the disease; The relative costs of the screening. There should be a suitable test or examination. The test should be acceptable to the population. 1.Acceptability 2.Repeatability 3.Validity:validity has two components i. Sensitivity ii. specificity Ability of the test to identify correctly all those who have the disease,and is called true positive.90 percent of sensitivity means 90 % of the disease people screened by the test will give a “true positive” result and the remaining 10% false negative. Ability of the test to identify correctly those who don’t have the disease, that is true negative.90% specificity means 90 percent of the non diseased person will give true negative result. Outcomes of a Screening Test True Disease Status Screening Test Positive Negative Total Positive True Positives a(TP) False Positives b(FP) TP+FP Negative False Negatives c(FN) True Negatives d(TN) FN+TN FP+TN TP+FP+FN+TN Total TP+FN a denotes true positive individuals with having disease. b denotes false positive test results and don’t have the disease. c denotes false negative test results but who have the disease. d denotes true negative who do not have the disease and test result is negati.ve Sensitivity =a/(a+c)100 Sepcificity =d/(b+d)100 DEFINATION Entry and development or multiplication of infectious agent in the body of man or animal . Sources of infection is defined as the person, animal ,object or substance from which an infectious agent passes or is disseminated to host. Reservoirs is defined as any person, animal arthropods or combination of these in which an infectious agent lives and multiplies, on which it reproduces itself in such a manner that it can be transmitted to a susceptible host. Types of Reservoirs 1) Human 2) Animal 3) Reservoir in non living. Definition of epidemiology The study of the health and the disease in human population and how these statuses are influenced by the environment and way of living. Study the pattern of the diseases among population. o Collection of data to understand the natural history to the disease which lead to formulation of hypothesis to explain the disease. Planning and evaluation of dental health services. To identify the etiological factors responsible for a disease. To identify special groups more susceptible to oral diseases and allow planning for preventive services. 1.Formulation of the hypothesis.It aim to put the idea of the investigator in the form of a null hypothesis, which is the starting point of any investigation. 2.Designing the investigation, using the methods of epidemiological studies 3.Selection of the sample. 4.Conducting the investigation, with the main three aspects when conduct the examinations The examination method. The diagnostic criteria. The indices used for measurements. .Analysis of data. Drawing the conclusion. Publishing the results. Many diseases are preventable through simple, non-medical methods as most common oral diseases (dental caries and periodontal diseases). Prevention of oral diseases depends upon data collected from the epidemiology of the diseases which can identify the etiological factors concern with the diseases and find the methods to control or prevent it. Prevention can divided into the following levels of preventive services. 1-Primary preventive services It is instruction and education of expectant mother (pregnant) to keep good oral hygiene of the child and include prevention. It is to prevent the initiation of the disease; they are designated as service that provides.Health promotion and specific protection. Specific protection activity includes services that are designated to protect against disease agent by decreasing the susceptibility of host or by establishing barrier against environment It is the prevention and reversing the progress of initial stages of disease or to arrest the disease progress before treatment become necessary e.g. Remineralization of carious lesion, fluoride, and dental sealant. Secondary preventive services: It is the employs routine treatment method to terminate a disease process and to restore tissue to as near as possible e.g. Restorative treatment, Endodontic treatment, Periodontal treatment. It is included the early diagnosis and the prognosis of treatment. Tertiary Preventive Services: These services directed toward the end result of disease, also can be referred as replacement therapy, these activities provide measures necessary to replace lost tissue and to rehabilitate patient to the point that function is near normal as possible e.g. prosthetic appliance and implant.