Community Dentistry Years I IV

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Community DentistryYears I - IV

• Dr David Locker
• Room 521 (ext 4490)

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Year I Term I

• Epidemiological methods
• Epidemiology of oral diseases
• Determinants of health and disease

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Year I Term II

• Current issues in dental health care

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Year II Term I

• Clinical epidemiology and critical appraisal

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Year II Term II

• Evidence-based care small groups learning

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Years III and IV

• Communication in dental practice
• Psychological and behavioural issues in dental
  practice
• Ethics in dentistry
• Jurisprudence

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Years I and II Providing clinical care to patients

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• What is the evidence re benefit?
• Is the evidence high quality?
• Is the evidence relevant?

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Year 1 Fall Term Lecture 1
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Introduction to Epidemiology
OBJECTIVES

• Nature and scope of epidemiology
• Contribution to dentistry and dental practice

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Two Types of Health Care
Clinical Practice

• Treats individuals
• With physical and psychological disorders
• Aims to RESTORE HEALTH

Population (Public) Health Practice

• Treats communities and populations
• Currently healthy
• Aims to PREVENT DISEASE and MAINTAIN HEALTH

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• Scientific study of the frequency, distribution
  and determinants of health and disease in human
  populations

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Causation
EXPOSURES INTERVENTIONS
OUTCOMES
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All decisions that health professionals make
health professionals make involve assumptions
about causal mechanisms
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Causal Relationships in Health Care
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• Comprehensive understanding of oral health and
  disease
• Understanding of scientific methods
• Causes of oral disease
• Evaluation of interventions
• Role in decisions re diagnosis and treatment
  for the individual patient

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Characteristics of Epidemiology

• Science
• Populations and population sub-groups
• Prevalence, incidence and risk

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Science

• A systematic set of methods for producing
  knowledge about events and their relationships
  which eliminates chance, bias and error.

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Power of Epidemiology
1854 London cholera epidemic 1940 Fluoride and
dental caries 1970 US toxic shock syndrome
epidemic
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London cholera epidemics1848-1854
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Table 1 Results of Snows Investigation
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Fluoride and dental caries(see attachment)
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Mechanisms by which fluoride considered to
inhibit dental decay
1. Pre-eruptive - reduce enamel solubility
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Mechanisms by which fluoride considered to
inhibit dental decay
2. Post-eruptive - promote remineralization -
inhibit bacterial acids
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Fluoride mechanisms
Better understanding of mechanisms Debate re
modes of delivery
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Toxic shock syndrome
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• Epidemiology is a logical discipline which
  proceeds by way of sequence of reasoning
• It is a comparative discipline in which causes of
  disease are identified by comparing its frequency
  in different groups
• Epidemiological investigations can lead to
  reductions in the frequency of disease even
  though biological mechanisms are not known

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Two Approaches to Explaining and Controlling
Disease
Environmental

• Focus on environmental, behavioural, lifestyle
  causes of disease

Mechanistic

• Focus on biological and pathological mechanisms
  which cause disease

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LUNG CANCER
CARCINOGENESIS
SMOKING
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Sequence of epidemiological reasoning
Observation Suspicion Hypothesis
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Epidemiological study Statistical
association Causal inference Prevention
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Types of Epidemiology
Classical

• Field epidemiology
• Descriptive epidemiology

Modern

• Analytic epidemiology
• Experimental epidemiology
• Clinical epidemiology
• Molecular epidemiology

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Current Applications of Epidemiology

• Identifying a new syndrome and its cause
• Assessing risks of exposures to harmful agents
• Identification of high risk groups
• Effectiveness of treatment and preventive
  technologies
• Needs for and trends in use of health services
• Variations in diagnosis and treatment planning
  among practitioners

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What is the oral health status of Ontarios
elderly? Is there an association between smoking
and the onset and course of periodontal
disease? Does community water fluoridation
increase the risk of hip fracture in the
elderly? Does the use of dental services by
adolescents decline after school dental programs
cease?
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How does chronic facial pain affect the quality
of life? Is this improved following consultation
and treatment at a specialist pain clinic? How
much variation is there in dentists diagnoses of
caries based on radiographs? What proportion of
the population avoid dental treatment because of
fear and anxiety, and how is this changing over
time?
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• ?

Does oral infection (periodontal disease)
increase the risk of major systemic disorders
such as heart disease, stroke and low birth
weight?