1. Community Dentistry

2. What is community dentistry?
• Community dentistry, also knows as dental public health, is
involved in the assessment of dental health needs and improving
the dental health of populations rather than individuals
• Public health dentistry is practiced generally through
governmentally sponsored programs, which are for the most part
directed toward public-school children in the belief that their
education in oral hygiene is the best way to reach the general
public.

3. Community Dentistry
• In the broadest sense, primary components of the dental public
health infrastructure include, but are not limited to:
• Government
• Education
• Workforce

4. Government
• State and local health departments, as well as federal agencies such as the
Indian Health Service (IHS), Federal Bureau of Prisons (BOP), the Centers
for Disease Control and Prevention (CDC), Health Resources and Services
Administration (HRSA), the Agency for Children and Families (ACF), and
National Institutes of Health (NIH). Other entities here would include the
Commissioned Corps of the U.S. Public Health Service (USPHS) and
Federally Qualified Health Centers (FQHCs). Education: Traditionally,
academia involved

5. Education
• Traditionally, academia involved in oral health includes schools of
Dentistry, Dental Hygiene, and Public Health. In recent years in light of a
greater emphasis on an interdisciplinary approach to patient care and
increased medical/dental collaboration, this area has expanded to include
Schools of Medicine, Nursing, and other allied Health Sciences. It also
includes preschool programs such as Head Start, primary and secondary
schools, trade schools, vocational educational programs, dental
residencies, and dental public health fellowships.

6. Workforce
• Dentists, dental hygienists, dental assistants, all members of the dental,
and many traditional non-dental providers: physicians, nurse practitioners,
physician assistants, midwives, pharmacists, nurses, home health aides,
water plant operators, teachers, parents, school administrators, health
boards, community health workers, and promotoras (culturally competent
or ethnically affiliated liaisons that bridge the gap within health care for
the underserved).

7. Examples of Community Dentistry
• Community water fluoridation: the controlled addition of a fluoride compound to a
public water supply to achieve a concentration optimal for dental caries prevention; All
water contains at least trace amounts of fluoride
• Sealant programs: The pits and fissures that characterize the biting surfaces of posterior
teeth provide a haven for food debris and decay-causing bacteria. Not surprisingly,
these sites are often the first and most frequent to be affected by decay in children and
adolescents. The width of most pits and fissures is narrower than a single toothbrush
bristle, making cleaning of their deepest recesses almost impossible. According to
national estimates, as much as 90 percent of all dental caries in schoolchildren occurs in
pits and fissures. The teeth at highest risk by far are permanent first and second molars
• Oral Health Education

8. Target Populations and Preventative
Strategies
• Term used to represent a certain segment of the population
that consists of groups of individuals with similarities of
some sort, such as:
• Age
• Race
• Educational background
• Life situation
• Health conditions

9. Pregnant patients
• The dental professional possesses the knowledge and
technology to assist parents in raising children free of
dental disease
• Women are particularly susceptible to periodontal disease,
because female hormones affect the periodontal structures.
• With bad oral hygiene, the predominant manifestations are
gingival enlargement, tissue sensitivity, and spontaneous
bleeding.

10. Pregnant patients cont…
• Tooth brushing can also be problematic if the mother is experiencing
morning sickness. The placement or movement of the toothbrush in
the posterior of the oral cavity may trigger an overactive gag reflex
that is common in morning sickness
• A relationship has been drawn between the incidence of periodontitis
and low birthweight (LBW), preterm babies
• It is important to provide oral health counseling throughout
pregnancy
• Proper nutrition during pregnancy is essential

11. Pregnant patients cont…
• Alteration of the dental chair incline
• It is recommended that the mother not be reclined completely in
the third trimester because of potential decrease in blood flow
and increase pressure to the fetus.
• Other suggestions are frequent breaks; radiographs should be
avoided in the first trimester
• Dental diseases left untreated during pregnancy can lead to
problems for both the mother and the fetus.
• The collaboration of medical and dental providers can ensure that
both the mother and the child are given the greatest opportunity
for optimal oral health.

12. Pediatrics
• Oral health is essential in children's overall health, functional
capacity, and social welfare.
• Due to an absence of dental care, children can experience pain,
infection, dysfunction, poor appearance, and low self-esteem as
well as drastic alterations to their ability to eat, communicate,
sleep, and play.
• By limiting children's experience of dental pain and infection,
their capacity to function well, grow normally, and engage in
normal activities will be enhanced.
• Every time a child is present for treatment, parental concerns
must be considered as well

13. Pediatrics cont…
• 3 Basic Child Temperaments
• Easy child
• Characterized by regularity, easy adaptability, and a positive mood in
the approach to new situations
• Difficult child
• Demonstrates considerable irregularity, many negative mood
expressions, slow adaptability, and frequently reacts negatively to new
situations
• Slow-to-warm-up child
• Low activity level and mild reactions, is somewhat negative, and shows
low adaptability

14. Pediatrics cont…
• Parents
• Influence how children think, socialize, and become self-
aware
• Level of anxiety in dental office that is experienced by
children is often a reflection of parental fears.
• Therefore, a child's behavior during the dental
appointment is affected significantly by the parents.

15. Pediatrics cont..
• Economics
• These kids are vulnerable to feelings of shame, anxiety, and anger.
• They are unable to coordinate behavior with identified authority,
particularly adults who are authoritative and seek compliance
• Low-income Families
• Children learn to communicate adversely, their vocabulary
development suffers, acquire language slowly, retain immature
pronunciations longer, and speak in shorter sentences.
• Therefore, it is suggested that the clinician speak slower, repeat
information more than usual, and use visual aids when
communicating with low-income children.

16. Pediatrics cont…
• Tell-Show-Do
• A straightforward strategy to help introduce a new
experience in conjunction with helping to minimize fear
of the unknown:
• Tell
• Verbal explanation that the patient understands
• Show
• Demonstration for the patient
• Do
• Completion of the procedure

17. Pediatrics cont…
• Positive Reinforcement
• The presentation of a stimulus immediately after desirable patient
behavior that results in an increase in the frequency of the behavior
• This includes:
• Verbal reinforcers
• “Good job”
• Physical demonstrations
• Shaking child's hand or stickers
• Nonverbal gestures
• Smile or thumbs up
• Tangible reinforcers
• Toys or stickers

18. Geriatrics
• People in the United States are living longer and healthier
lives than ever before.
• The present geriatric population is one of the fastest
growing segments of our society.
• Moreover, increasing numbers of “well elderly” are able to
retain their natural teeth and enjoy normal oral function
throughout old age
• Oral health professionals must be aware of the special
management needed to treat this group of patients

19. Geriatrics
• The most common illnesses found in older American adults
are arthritis, hypertension, impaired hearing, heart disease,
and impaired vision
• For the first time in recorded history, there are now more
older adults with natural teeth than without teeth; therefore,
they are able to maintain functional dentition.
• This decline in edentulism appears to be the result of water
fluoridation, increased public awareness of preventive
approaches, improved access to services, and a decrease in
early tooth loss

20. Geriatrics
• Many frail older adults can be seen at a regular dental
office, provided that they are mobile and the office is
accessible and senior-friendly
• Oral health care professionals must address how this aging
population will manage in a variety of dental settings, and
at a minimum, have accessible senior-friendly offices,
medical history forms printed in large type, as well as
easy-to-read signs, health literature, and appointment
cards

21. Medically Compromised Population
• It is important for professionals to understand what oral
changes may occur as a result of an altered medical state.
• The dental professional should be aware of approaches
unique to each patient and their condition

22. Arthritis
• Arthritis literally means joint inflammation
• Consider the need for shorter visits.
• Allow the patient to walk around as needed, adjust any
physical supports, or change position frequently while in
the dental chair.
• The patient with an arthritic condition may not have the
strength, movement, or dexterity to perform typical self-
care regimens

23. Eating Disorders
• Two most common eating disorders are anorexia and
bulimia
• The practitioner must pay special attention to the condition
of the teeth.
• These patients commonly present with evidence of damage
due to their carbohydrate intake and acid intake
• These patients should be placed on a self-care fluoride
regimen in addition to professionally applied fluoride

24. Erosion Due to Bulimia

25. Cancer
• The dental professional should start with a thorough health
history of their patients at each visit, followed by an oral
cancer screening
• Some oral manifestations
• Xerostomia (dry mouth)
• Ulcers
• Increased susceptibility to infection
• Poor healing
• Important that infection does not perpetuate in the oral cavity and
compound the patients condition
• Maintaining the teeth and tissue will allow the patient to eat property
and regain a healthier state

26. Cancer
• Saliva substitutes should be recommended to keep the oral
cavity moist
• Self-care fluoride treatments are most beneficial for
patients with cancer.
• Most common risk factors are tobacco use, unprotected
sun exposure, poor diet, infectious diseases, chemicals,
and radiation exposure

27. Heart Disease
• Patients may express a number of the same problems that cancer
patients have due to medication usage
• Xerostomia
• Gingival bleeding
• Rampant caries
• Patients with congestive heart failure will also be uncomfortable
in the chair if the chair is reclined
• Brings increased fluid around the heart and patients feel as if they are
suffocating

28. Tobacco
• Cigarette smoking is the most popular means of tobacco
use, however, smokeless tobacco is also very popular
• Patients who use tobacco are seen to have greater
incidence of periodontitis and a higher caries rate
• The most important role of the dental provider is to
educate patients to not engage in these types of damaging
activities

29. Summary

36. Developmental Disabilities
• Dental professionals need an understanding of the limits
and conditions that could possibly affect patients who have
disabilities.
• Populations with developmental disabilities can have
varying degrees of functional level
• Preventive care is provided through the individual or the
caregiver.
• Goals
• Need regular maintenance appointments
• Individualized treatment plans for individual's abilities
• Sufficient use of preventive aids

37. Developmental Disabilities
• Although patients with developmental disabilities are able
to brush their own teeth, it is very important to intimately
involve the patient's primary caregiver in oral hygiene
instruction.
• Personalized techniques can be demonstrated and
explained to suit each patient's needs