Dental Public Health (DPH) 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 vary due to availability of resources. Similar to

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

, an understanding of the many factors that influence

health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

will assist the implementation of effective strategies. Dental-related diseases are largely preventable. Public health dentistry is practiced generally through government sponsored programs, which are for the most part directed toward public-school children in the belief that their education in

oral hygiene Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular brushing of the teeth (dental hygiene) and cleaning between the teeth. It is important that oral hygiene be carried out ...

is the best way to reach the general public. The pattern for such programs in the past was a dental practitioners annual visit to a school to lecture and 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 and 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.Tyack D. Health and social services in public schools: Historical perspectives. The Future of Children. 2017.

Background

Even with

fluoridation Water fluoridation is the controlled adjustment of fluoride to a public water supply solely to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by addin ...

and

tooth decay Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complicatio ...

is still the most common diet–related disease affecting many people. Tooth decay has the economic impact of heart disease,

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...

and

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

. Tooth decay is, however, easily prevented by reducing acid demineralisation caused by the remaining

dental plaque Dental plaque is a biofilm of microorganisms (mostly bacteria, but also fungi) that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found be ...

left on teeth after brushing. Risk factors for

include physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typically a few micrometr ...

, inadequate salivary flow, insufficient fluoride exposure, poor

, inappropriate methods of feeding infants, and poverty. Neutralising acids after eating and at least twice a day brushing with fluoridated toothpaste will assist prevention.

Cavities Cavity may refer to: Biology and healthcare *Body cavity, a fluid-filled space in many animals where organs typically develop **Gastrovascular cavity, the primary organ of digestion and circulation in cnidarians and flatworms *Dental cavity or too ...

can develop on any surface of a

tooth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, t ...

, 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 Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) that is attached ...

and

periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cau ...

are caused by certain types of

that accumulate in remaining

. The extent of

gum disease Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main caus ...

depends a lot on host susceptibility. Daily brushing must include brushing of both the

teeth A tooth ( : teeth) is a hard, calcified structure found in the jaws (or mouths) of many vertebrates and used to break down food. Some animals, particularly carnivores and omnivores, also use teeth to help with capturing or wounding prey, t ...

and

gums The gums or gingiva (plural: ''gingivae'') consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health. Structure The gums are part of the soft tissue lin ...

. Effective brushing itself, will prevent progression of both tooth decay and

s. Neutralising acids after eating and at least twice a day brushing with fluoridated toothpaste will assist preventing

dental decay Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complicatio ...

. Stimulating saliva flow assists in the

remineralisation In biogeochemistry, remineralisation (or remineralization) refers to the breakdown or transformation of organic matter (those molecules derived from a biological source) into its simplest inorganic forms. These transformations form a crucial link ...

process of teeth, this can be done by chewing sugar free gum. Using an interdental device once daily will assist prevention of

s. 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 (ABDPH) 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.

Scope

Major areas of dental public health activity include: *Oral health surveillance National Oral Health Surveillance system (NOHSS) is designed to monitor the effects of oral disease on the population, as well as monitor how the oral care is delivered. Additionally, the status of water fluoridation on both a state and a national level is continually supervised. *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

Dental health is concerned with promoting health of an entire population and focuses on an action at a community level, rather than at an individual clinical approach. Dental public health is a broad subject that seeks to expand the range of factors that influences peoples oral health and the most effective means of preventing and treating these oral health problems. 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

Water fluoridation Water fluoridation is the controlled adjustment of fluoride to a public water supply solely to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding ...

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 Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation. It appears as a range of visual changes in enamel causing degrees of intrinsic tooth d ...

. 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 Calcium fluoride is the inorganic compound of the elements calcium and fluorine with the formula CaF2. It is a white insoluble solid. It occurs as the mineral fluorite (also called fluorspar), which is often deeply coloured owing to impurities. ...

. 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 the Grand rapid 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. Water-fluoridation-extent-world-equirectangular

Water-fluoridation-extent-world-equirectangular

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 therapist A dental therapist is a member of the dental team who provides preventive and restorative dental care for children and adults. The precise role varies and is dependent on the therapist's education and the various dental regulations and guidelines o ...

s and

dental hygienist A dental hygienist or oral hygienist is a licensed dental professional, registered with a dental association or regulatory body within their country of practice. Prior to completing clinical and written board examinations, registered dental hygien ...

. 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.

Approaches to promotion

Oral health promotion outlines the strategies for improving and educating the general public about how they can better take improve and maintain their current oral health. Oral health promotion is part of both government and private incentives to create a healthier and better educated generation of individuals. Below are the nine key principles involved for oral health promotion: Three ways to achieve oral health promotion include addressing the determinants of oral health, ensuring community participation, and implementing a strategy approach that involves a range of complementary actions.

Determinants of oral health

Oral health promotion focuses on individual behaviour, socioeconomic status and environmental factors. Underlying determinants, including non-milk extrinsic sugars consumption, alcohol consumption and smoking, can impact oral health. The ability to remove dental plaque, exposure to fluoride and access to quality dental care can affect the ways the aforementioned underlying factors are and can be modified to the needs of the individual to obtain optimum oral health. Ways in which oral health promotion can minimise the effects of these determinants include: * Promoting healthy eating. * Teaching effective oral hygiene practices. * Promoting the use of topical fluoride for preventing and control of

dental caries Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complicat ...

. * Facilitating early access to preventative dental services. These factors are also influenced by sociopolitical considerations that are outside the control of most individuals. Community participation is a key factor in oral health promotion. Inter-sectoral collaboration is where relevant agencies and sectors are involved in partnership to identify key oral health issues and to implement new methods to improve oral health. The

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...

has agreed on a health promotion approach as the foundation for oral health improvement strategies and policies for the population. Oral health promotion is based on the principles of the framework, Ottawa Charter. There are five areas of action outlined to achieve oral health promotion; building Health public policy, creating supportive environment, strengthening community action, developing personal skills, re-orienting healthcare services.

Research

Oral health in care homes

A study investigating the efficacy of staff workers' oral care education on improving the oral health of care home residents found that despite the education and training of care workers, certain ongoing barriers prevented them from conducting the necessary daily oral hygiene care for the residents. The most frequently listed obstacles to care included the residents' bad breath, inadequate time to perform oral care and uncooperative residents who do not perceive the need for oral care. Another study on the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health for nursing home residents shows insufficient supporting evidence.

School dental screening programs

It is unclear whether or not school screening programs improve attendance at the dentist. There is low-certainty evidence that school screening initiatives with incentives attached, such as free treatment, may be helpful in improving oral health of children.

One-to-one oral hygiene advice provided in a dental setting for oral health

One-to-one oral hygiene advice (OHA) is often given on a regular basis to motivate individuals and to improve one's oral health. However, it is still unclear if one-to-one OHA in a dental settings is effective in improving one's oral health. Regardless of the increased oral hygiene education programs in schools due to the higher quality of life, there is an increased intake of processed food, especially of sweetened beverages. The favorable effect of the increased level of dental health education may be counteracted by nutritional behavior, especially sweets intake and low attendance of regular dental office check-ups and insufficient oral health practices (tooth brushing) generating a still increased caries prevalence and DMFT index in adolescents. Irregular dental check-up and sugary dietary habits were associated with high prevalence the occurrence of dental conditions as assessed by the decayed, missing (due to caries), and filled teeth (DMFT) index.

Community-based population level interventions for promoting child oral health

A systematic review sought to determine the effectiveness of different interventions in preventing dental caries in children and when was the most effective time to intervene during childhood. Overall, the evidence showed low certainty that combining oral health education alongside supervised tooth-brushing or professional intervention would reduce dental caries in children (from birth to 18). The most effective time to intervene in childhood was still unclear as well. Improving the diets of children and the access to fluoride showed only a limited impact to improving the oral health of children.

Examples

Australia

Child Dental Benefits Schedule (CDBS)

*A Government funded program which provides assistance for basic dental services for children aged 2–17 years. Services provided include: examinations, dental x-rays,

cleaning Cleaning is the process of removing unwanted substances, such as dirt, infectious agents, and other impurities, from an object or environment. Cleaning is often performed for aesthetic, hygienic, functional, environmental, or safety purposes ...

, fissure sealants, fillings, extractions and

root canals In vascular plants, the roots are the organs of a plant that are modified to provide anchorage for the plant and take in water and nutrients into the plant body, which allows plants to grow taller and faster. They are most often below the sur ...

*Th
CDBS
is means tested, those who qualify are eligible to $1,000 of the aforementioned treatments over a two-year period. To find out if a child is eligible, families can contact th
Department of Human Services

National Partnership Agreement on Adult Public Dental Services

*As part of th
National Partnership Agreement on Adult Public Dental Services
between 2015- 2016 $155 million was provided to service around 178,000 adult public patients *On 15 December 2016, a further $320 million was provided by the

Australian Government The Australian Government, also known as the Commonwealth Government, is the national government of Australia, a federal parliamentary constitutional monarchy. Like other Westminster-style systems of government, the Australian Government ...

for dental services to public adult patients; the funding is to last for three years.

Autonomous Region of Madeira - Portugal

In 1985 three dentists with the sponsorship of Colonel Joy Wheeler Dow, Jr., implemented an Oral Health Program in the Autonomous Region of Madeira with the aid of five assistants. The four-year program reached 15,000 children around the main island and Porto Santo and it included Oral Hygiene Instruction classes, informative literature including films, fortnightly fluoride mouth-rinse and daily fluoride tables with the collaboration of the school teachers. During this period a study was undertaken using the

(WHO) Combined Oral Health Assessment (CPTIN) plan resulting in the final report where it was found that there had been a decrease of 44% in the need for fillings, 40% decrease in the need for extractions, whilst the caries free children population grew from the initial 1% to 5%.

United Kingdom

National Health Service (NHS) dentistry

National Health Service (NHS) is the name of the public health services of England, Scotland and Wales and is directly funded from

tax A tax is a compulsory financial charge or some other type of levy imposed on a taxpayer (an individual or legal entity) by a governmental organization in order to fund government spending and various public expenditures (regional, local, or n ...

ation. The dentistry services are available to all, regardless of wealth. In order to find a NHS dentist searc
NHS Dentist Near You
Some clinics may not have the capacity to take on new patients so waiting lists may occur. *Availability of treatment All treatment deemed necessary to maintain optimal oral health will be provided by the dentist, however not all treatments will be funded by the Dentistry NHS and will incur private fees. *Fee's Dentistry performed under the Dentistry NHS will involve fees, however are heavily subsidized by the government, below is some information which explains how the fee’s system works, only one charge is required per treatment course of care, regardless of the amount of appointments needed

Nepal

Nepalese population is at a greater disadvantage than westernized societies in terms of oral health. The benefit of implementing health insurance is to assist a large number of people with similar risks by sharing funding. In Nepal, implementing health insurance is difficult due to limited supply of finances. To assist families with accessing health care “elimination of direct payments is necessary but is not sufficient alone; costs of transportation and loss of income can have more impact than direct payment of services” must be considered.

Education

Oral Health Promotion in Nepal - teaching children

*The amount of dental professionals produced from tertiary education has increased in Nepal over the years, but remains low in comparison to the rest of the world. There were approximately only 100 dentists in the workforce in the year 2000, which has increased to 240 in the present. *Nepal is now using dental hygienists, therapists and oral health therapists to increase access to dental treatment. *Programs such as training rural women about oral health promotion are being utilized to increase awareness of basic dental problems in remote areas.

Dental outreach program

*Attempts to reduce the gap in dental health of Nepalese people through volunteer work provides oral health care education and basic treatment to small villages. *Services provided include oral hygiene instruction, distribution of free toothbrush and fluoride toothpaste, application of fluoride gel, application of sealant, screening and charting out treatment plan under a supervising dentist, scaling, filling, extraction, prescribing medicine, and free dispensing distributing medicines For more information, you can access th
Around Good People fact sheet

Early history

The earliest known person identified as a dental practitioner dates back to 2600BC, an Egyptian scribe states that he was ‘the greatest of those who deal with teeth ad of physicians’ Older barber-dentist

*1500BC- Egyptian Ebers papyrus explains oral disease and offers prescription for strengthening

and

* 9th century AD- The Arabs discussed the care of

rather than extractions and replacement. Mouth hygiene was established with a small wooden stick * Late 1400s- The first tooth brush was invented by the Chinese * 1723- A French surgeon describes a comprehensive care system for dentistry including restorative techniques and denture reconstruction * 1791- The first dental treatment available for the poor, established in New York City * 1840- The world's first national dental organisation was founded * 1861-

Philadelphia Philadelphia, often called Philly, is the List of municipalities in Pennsylvania#Municipalities, largest city in the Commonwealth (U.S. state), Commonwealth of Pennsylvania, the List of United States cities by population, sixth-largest city i ...

n charity hospital offers dental services * 1865- First ever children’s dental clinic, established in

Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...

* 1867- Boston opened its first low income dental clinic * 1884- The term

Oral Hygiene Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular brushing of the teeth (dental hygiene) and cleaning between the teeth. It is important that oral hygiene be carried out ...

come about when ML Rhein asks dentists to teach patients how to brush their teeth * 1890- A committee in

England England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...

carried out oral hygiene promotion in schools * 1896- The powerful slogan ‘A clean tooth never decays’ helps improves standards of mouth hygiene * 1931- Fluoride is identified * 1945- First ever water fluoridation * 1969-

(WHO) establishes a data bank which collect information on dental health and needs * 1996
WHO Oral Health Country/Area Profile Program (CAPP)
is established, this online database presents information on individual countries oral health services and oral disease rates Hiremath S. Textbook of Preventive and Community Dentistry. 2nd ed. Elsevier India; 2011.

References

External links

U.S Community Dental and Oral Health Programs

Dental public health, American Dental Association (PDF)
{{DEFAULTSORT:Dental Public Health Dentistry branches Public health