1. Dental Public HealthDental Public Health

2. Dental Public HealthDental Public Health
IntroductionIntroduction

3. Topics
Historical Development
Dental Care Delivery
in the United States
around the world
Financing Dental Care
Legislative Initiatives
Education and Promotion
Target Populations
Lesson Plan
Program Planning
Program Evaluation
Oral Epidemiology
Research Methods
Biostatistics
Evaluation of Literature
and Products
Careers in the Government
Entreprenurial Initiatives
Board Review

4. The Prevention
Movement
Cosmic Smiles Pediatric
Dentistry Relation to Dental
Public Health

5. Historical Development
Dental Hygiene as
Forerunner to the
Prevention Movement
Dr. Alfred Fones
Founder of Dental
Hygiene School and
First Author of Dental
Hygiene College
Textbook

6. Historical Development
Continued
• Practice Settings
– Schools
– Industry
– Military
– Hospitals
• Professional
Organizations

7. Preventive ModalitiesPreventive Modalities
Dental Hygiene TreatmentDental Hygiene Treatment
FluoridationFluoridation
XylitolXylitol
Dental SealantsDental Sealants
Oral Cancer Exams and Tobacco CessationOral Cancer Exams and Tobacco Cessation
Nutritional CounselingNutritional Counseling
Atraumatic Restorative Treatment (ART)Atraumatic Restorative Treatment (ART)
Mass Education/MediaMass Education/Media

8. Dental Care DeliveryDental Care Delivery
In the United StatesIn the United States

9. Dental Care DeliveryDental Care Delivery
F E D E R A L
D e p a rtm e n ts o f th e
F e d e ra l G o v e rn m e n t
N O N G O V E R N M E N T
P riv a te P ra c tic e
In s titu tio n s , S c h o o ls
In s u ra n c e -B a s e d M o d e ls
S T A T E
D e p a rtm e n ts o f S ta te
S ta te P ris o n s
C o m m u n ity C lin ic s , S c h o o ls
V e h ic le s o f D e n ta l C a re
in th e U n ite d S ta te s

10. Dental Public Health
The oral health care and education,
with an emphasis on the utilization
of dental hygiene sciences,
delivered to a target population

11. Factors Affecting Dental Health
Access to Care
Restriction of dental
hygiene services
Shortage of Medicaid
providers
Financial Situations
Insurance
Medicaid
Transportation

12. Factors Affecting DentalFactors Affecting Dental
Health, ContinuedHealth, Continued
SES Relation toSES Relation to
Dental HealthDental Health
Dental HygieneDental Hygiene
SciencesSciences
Increase in theIncrease in the
GeriatricGeriatric
PopulationsPopulations
MalpracticeMalpractice
Insurance ChangesInsurance Changes

13. Federal InfluenceFederal Influence
Executive Branch System
Legislation Senate and House of
Representatives
Executive President and
Cabinet
Judicial Federal Court

14. Department of Health andDepartment of Health and
Human ServicesHuman Services
• Public Health ServicePublic Health Service
Operating DivisionOperating Division
• Human ServicesHuman Services
Operating DivisionOperating Division

15. Public Health ServicePublic Health Service
Operating DivisionOperating Division
National Institutes ofNational Institutes of
HealthHealth
Food and DrugFood and Drug
AdministrationAdministration
Centers for DiseaseCenters for Disease
Control andControl and
PreventionPrevention
Agency for ToxicAgency for Toxic
Substances andSubstances and
Disease RegistryDisease Registry
Indian Health ServicesIndian Health Services
Health Resources andHealth Resources and
Services AdministrationServices Administration
Agency for Health CareAgency for Health Care
Policy and ResearchPolicy and Research
Substance Abuse andSubstance Abuse and
Mental Health ServicesMental Health Services
AdministrationAdministration

16. Human Services Operating
Division
 Centers for Medicaid
and Medicare
– Medicaid
– Medicare
 Administration for
Children and Families
 Administration on Aging

17. Public Health Service
PHS works toward
improving and
advancing the
health of our
nation.
U.S. Surgeon
General
Dental Hygienists
work as Public
Health Officers.

18. Other Federal DepartmentsOther Federal Departments
Influencing Dental CareInfluencing Dental Care
AgricultureAgriculture
DefenseDefense
EducationEducation
JusticeJustice
LaborLabor
StateState
TreasuryTreasury
Veteran’s AffairsVeteran’s Affairs
United States PeaceUnited States Peace
Corps (which is anCorps (which is an
executive branchexecutive branch
agency)agency)

19. Individual State InfluenceIndividual State Influence
State DentalState Dental
DivisionsDivisions
MedicaidMedicaid
S-CHIPSS-CHIPS
PrisonsPrisons
Tribal ClinicsTribal Clinics
InstitutionsInstitutions
Community ClinicsCommunity Clinics

20. Dental Health Care PersonnelDental Health Care Personnel
 NeedNeed
 DemandDemand
 UtilizationUtilization
 SupplySupply
 Dental HygieneDental Hygiene
ShortagesShortages
 Dental HygienistDental Hygienist
to Dentistto Dentist
EmploymentEmployment
Ratio = 1:2Ratio = 1:2

21. Dental FinanceDental Finance
Public and PrivatePublic and Private
Funding of Dental CareFunding of Dental Care

22. Historical Funding of Dental Care
 Patient’s Responsibility
 The Advent of Dental
Insurance
 Medicaid Coverage for
Dental Services
 Today’s Dental
Financing

23. Payment MethodsPayment Methods
Fee-for-ServiceFee-for-Service
Capitation PlansCapitation Plans
Encounter Fee PlansEncounter Fee Plans
Barter SystemBarter System

24. Fee-for-Service
A dental practice sets
a fee, and a patient
and/or third party pays
for the fee.
UCR: usual,
customary and
reasonable fee
Indemnity plans pay
fee-for-service.
Discounted coverage
available and sliding
scales for certain
patients in certain
clinics

25. Capitation MethodCapitation Method
 Dental Managed CareDental Managed Care
 A certain amount is paid to a dentalA certain amount is paid to a dental
practice for a certain number of patients.practice for a certain number of patients.
Payment is received whether treatment isPayment is received whether treatment is
provided or not.provided or not.
 Many times employees will state that theyMany times employees will state that they
are not paid for “cleanings” provided;are not paid for “cleanings” provided;
however, this is not an accuratehowever, this is not an accurate
statement.statement.

26. Encounter and BarterEncounter and Barter
 Encounters are for anEncounters are for an
arrangement paid forarrangement paid for
each visit.each visit.
 Barter system is usedBarter system is used
when the dentalwhen the dental
provider negotiatesprovider negotiates
payment bypayment by
exchanging goodsexchanging goods
and services.and services.

27. Insurance PlansInsurance Plans
Dental Service CorporationsDental Service Corporations
Health Service CorporationsHealth Service Corporations
Preferred Providers OrganizationsPreferred Providers Organizations
Individual Practice AssociationsIndividual Practice Associations
Capitation ProgramsCapitation Programs

28. Dental BillingDental Billing
 Claim FormClaim Form
 ADA CDTADA CDT
 Payment PlansPayment Plans
 Dental Credit CardsDental Credit Cards
 Explanation ofExplanation of
BenefitsBenefits

29. Government Role
• Research
• Disease Prevention
• Disease Control
• Program Planning and Operation
• Funding for the Education of
Dental Professionals
• Regulation

30. Government’s Role
• U.S. PHS
• Federal Block
Grants
• State Governments
• Local Governments

31. Medicaid
 Title XIX
 State/Federal
Program
 Your State’s
Medicaid Program
 Other State’s
Medicaid Program

32. Dental Care DeliveryDental Care Delivery
Around the WorldAround the World

33. International Dental
Health Care
• Dental Diseases
• Historical Perspective
• Demographics and the Dental
Hygienist
• Global Education of the Dental
Hygienist
• The Role of the Dental Hygienist
• Access to Care in Other
Countries

34. International Dental
Health Care, Continued
• Dental Public Health
Programs and
Campaigns
• Oral Health Policies
• Lobbying Groups
• International Dental
Organizations

35. International OverviewInternational Overview
Related DentalRelated Dental
ProfessionalsProfessionals
Regulation of DentalRegulation of Dental
HygienistsHygienists
IndependentIndependent
PracticePractice
Portability ofPortability of
LicensureLicensure
Future of DentalFuture of Dental
HygieneHygiene

36. Legislative InitiativesLegislative Initiatives
Affecting Dental HygieneAffecting Dental Hygiene
PracticePractice
In the United StatesIn the United States

37. Issues in the United States
Preceptorship/Alternative Education
On-the-Job Training for Supragingival
Scaling
Restrictive Supervision Laws Affecting
Access to Care
Advanced Dental Hygiene Practitioner

38. State Governments
 Legislative
 Executive
 Judicial

39. Major Bodies of LawMajor Bodies of Law
 Common LawCommon Law
 Statutory LawStatutory Law
 ConstitutionalConstitutional
LawLaw
 AdministrativeAdministrative
LawLaw

40. Laws Pertaining to DentalLaws Pertaining to Dental
HygieneHygiene
• State Dental Hygiene
Practice Act,
sometimes referred to
as the statute
• Supervision Status

41. State Dental BoardState Dental Board
• Administrative LawAdministrative Law
• Governs Dental Hygienists and theGoverns Dental Hygienists and the
Practice of Dental HygienePractice of Dental Hygiene
• Rules and RegulationsRules and Regulations
• Self-RegulationSelf-Regulation

42. Supervision TypesSupervision Types
UnsupervisedUnsupervised
Independent PracticeIndependent Practice
Collaborative PracticeCollaborative Practice
General SupervisionGeneral Supervision
Indirect SupervisionIndirect Supervision
Direct SupervisionDirect Supervision

43. International OverviewInternational Overview
Related DentalRelated Dental
ProfessionalsProfessionals
Regulation of DentalRegulation of Dental
HygienistsHygienists
IndependentIndependent
PracticePractice
Portability ofPortability of
LicensureLicensure
Future of DentalFuture of Dental
HygieneHygiene

44. Dental HealthDental Health
Education and PromotionEducation and Promotion

45. Health Education PrinciplesHealth Education Principles
Five DimensionalFive Dimensional
Health ModelHealth Model
– PhysicalPhysical
– MentalMental
– SocialSocial
– SpiritualSpiritual
– EmotionalEmotional

46. Dental Health EducationDental Health Education
Goal: to preventGoal: to prevent
dental diseasesdental diseases
utilizing appropriateutilizing appropriate
dental healthdental health
interventionsinterventions

47. Health Education PrinciplesHealth Education Principles
Health Education: the education of healthHealth Education: the education of health
behaviors that bring an individual to a state ofbehaviors that bring an individual to a state of
health awarenesshealth awareness
Health Promotion: the informing andHealth Promotion: the informing and
motivating of people to adopt healthmotivating of people to adopt health
behaviorsbehaviors
Health Behavior: an action that helps preventHealth Behavior: an action that helps prevent
illness and promotes health for a populationillness and promotes health for a population

48. Goals of Dental Health Education
Provide Effective Dental Health
Education.
Change Values Aimed at Improving
Health.
Healthy Behaviors

49. Stages of LearningStages of Learning
• Unawareness
• Awareness
• Self-Interest
• Involvement
• Action
• Habit

50. Transtheoretical ModelTranstheoretical Model
 PrecontemplationPrecontemplation
 ContemplationContemplation
 PreparationPreparation
 MaintenanceMaintenance
 ActionAction

51. Theory of Reasoned ActionTheory of Reasoned Action
Attitude toward the behaviorAttitude toward the behavior
Subjective normsSubjective norms
Perceived behavioral controlPerceived behavioral control
IntentionIntention
BehaviorBehavior

52. Social Cognitive Theory
• Self-Efficacy Theory
• Knowledge –
Behavior –
Environment

53. Empowerment Models
• Participant Oriented
• Social Environments

54. Motivation
• Motivation is the
will of the
individual to act.

55. Maslow’s Heirarchy of Needs
 Self-Actualization
 Need for Self-Esteem
 Belongingness and
Love
 Safety Needs
 Physiological Needs

56. Behavioral Conditioning
 Classical
Conditioning
 Operant
Conditioning
 Modeling

57. Lesson PlanLesson Plan
DevelopmentDevelopment

58. Assessment PhaseAssessment Phase
 Assess target populations’Assess target populations’
 needsneeds
 interestsinterests
 abilitiesabilities
 Assess resourcesAssess resources

59. Dental Hygiene Diagnosis
Formulate Findings
from Assessment
into a Diagnosis.
Prioritize Goals.

60. PlanningPlanning
Broad GoalBroad Goal
FormulationFormulation
Specific ObjectivesSpecific Objectives
Select TeachingSelect Teaching
Methods.Methods.

61. Implementation
 Be Prepared.
 Effective Teacher
Characteristics

62. EvaluationEvaluation
• Qualitative MeasurementQualitative Measurement
• Quantitative MeasurementQuantitative Measurement
• Information Provided to AppropriateInformation Provided to Appropriate
PartiesParties

63. Target PopulationsTarget Populations
For the Practicing HygienistFor the Practicing Hygienist

64. Target PopulationsTarget Populations
A group of individuals withA group of individuals with
similarities of some sort whether it besimilarities of some sort whether it be
age, race, educational background,age, race, educational background,
life situations, and/or healthlife situations, and/or health
conditionsconditions

65. Specific Target PopulationsSpecific Target Populations
 Family CaregiversFamily Caregivers
 Health CareHealth Care
WorkersWorkers
 Hospice WorkersHospice Workers
 Persons withPersons with
MedicalMedical
Conditions/Conditions/
DiseasesDiseases
 DevelopmentallyDevelopmentally
DisabledDisabled
 Hearing ImpairedHearing Impaired
 VisualVisual
ImpairmentsImpairments
 SchoolSchool
TeachersTeachers
 Social WorkersSocial Workers
 AgesAges
 PrenatalPrenatal
 InfancyInfancy
 ChildrenChildren
 AdultsAdults
 Older AdultsOlder Adults

66. Cultural DiversityCultural Diversity
The social, ethnic, and culturalThe social, ethnic, and cultural
elements that compose a person.elements that compose a person.

67. Barriers to Dental Hygiene and
Dental Care
Age Language Habit
Culture No Finances Lack of Faith
Education Misunderstanding Fear
Transportation Values Safety
Illiteracy Attitudes Denial of Disease
No providers Invulnerability Convenience
Social Issues Education Levels Provider Conflicts

68. Program PlanningProgram Planning
For the Dental HygienistFor the Dental Hygienist

69. What is a dental public health
program?
Educational, clinical,
and referral services to
a target population

70. Preventive Programs
• School Fluoride Mouthrinse Programs
• School Dental Sealant Programs
• Xylitol Programs
• Mouthguard Programs
• Dental Health Educational Programs
• Tobacco Cessation Programs
• Denture Identification Programs

71. Dental Public Health ProgramsDental Public Health Programs
► Healthy Smile ProgramHealthy Smile Program
► Inner City HealthInner City Health
Center Dental ProgramCenter Dental Program
► Soroptomist DentalSoroptomist Dental
ProjectProject
► Matthew 25Matthew 25
► Operation SmileOperation Smile

72. Dental Hygiene ProgramDental Hygiene Program
Planning ParadigmPlanning Paradigm
 AssessmentAssessment
 Population’s dental needsPopulation’s dental needs
 DemographicsDemographics
 FacilityFacility
 PersonnelPersonnel
 Existing ResourcesExisting Resources
 FundingFunding

73. Dental Hygiene ProgramDental Hygiene Program
Planning Paradigm, ContinuedPlanning Paradigm, Continued
Dental Hygiene DiagnosisDental Hygiene Diagnosis

Prioritization of needsPrioritization of needs

Formulation of diagnosis to provide goals andFormulation of diagnosis to provide goals and
objectives for blueprintobjectives for blueprint
PlanningPlanning

Methods to measure goalsMethods to measure goals

BlueprintBlueprint

Address constraints and alternatives.Address constraints and alternatives.

74. Dental Hygiene ProgramDental Hygiene Program
Planning Paradigm, ContinuedPlanning Paradigm, Continued
ImplementationImplementation

Program will begin operation.Program will begin operation.

Revision and changes identified andRevision and changes identified and
employedemployed
EvaluationEvaluation

Measuring goalsMeasuring goals

Qualitative and quantitative evaluationQualitative and quantitative evaluation

Ongoing revisions employedOngoing revisions employed

75. Program EvaluationProgram Evaluation
Dental Public HealthDental Public Health

76. Program EvaluationProgram Evaluation
 Program PlanningProgram Planning → Objectives→ Objectives
 Measurement of ObjectivesMeasurement of Objectives
 FormativeFormative
 SummativeSummative

77. Evaluation Techniques
 Traditional Nonclinical Measurements
 Interviews
 Surveys
 Clinical Methods
 Basic
 BSS
 Dental Indexes

78. Government’s EvaluationGovernment’s Evaluation
• Healthy People 2010Healthy People 2010
Objectives andObjectives and
EvaluationEvaluation
MechanismsMechanisms
• NOHSSNOHSS
• Call to ActionCall to Action

79. Oral Epidemiology
• Study of Oral Diseases
• Multifactorial Nature of Disease
• Terminology
• Epidemic Prevalence
• Endemic Incidence
• Pandemic Etiology
• Disease Rates Surveilance
• Mortality Risk Factors
• Morbidity Index

80. Oral Epidemiology ReportsOral Epidemiology Reports
Morbidity andMorbidity and
Mortality (MMWR)Mortality (MMWR)
Healthy PeopleHealthy People
ReportsReports
Surgeon General’sSurgeon General’s
ReportReport
Call to ActionCall to Action
Global Oral DataGlobal Oral Data
BankBank

81. Epidemiology of Oral DiseasesEpidemiology of Oral Diseases
Periodontal DiseasesPeriodontal Diseases
Tooth LossTooth Loss
Dental CariesDental Caries
Oral CancerOral Cancer
Cleft Lip/PalateCleft Lip/Palate
InjuryInjury
ToothachesToothaches

82. ResearchResearch
In Dental HygieneIn Dental Hygiene

83. Significance of ResearchSignificance of Research
to Dental Hygieneto Dental Hygiene
Dental public health is basedDental public health is based
upon programs that haveupon programs that have
demonstrated effectiveness indemonstrated effectiveness in
achieving health for theachieving health for the
population.population.

84. Types of Research
 Historical
 Descriptive
 Survey
 Observational
 Case Studies
 Correlational
 Epidemiological
 Longitudinal
 Cross-sectional
 Retroactive
 Experimental
(Prospective)
 Quasi-experimental

85. Beginning Research
 Research Question
 Does Brand X toothpaste whiten teeth?
 Positive Hypothesis
 Brand X toothpaste does significantly
whiten teeth.
 Null Hypothesis
 There is no statistically significant
difference between Brand X and a placebo
when comparing the whitening of teeth.

86. Research DesignResearch Design
Formulating a hypothesisFormulating a hypothesis
Review of the literatureReview of the literature
Methods and materialsMethods and materials
Statistical evaluationStatistical evaluation

87. Experimental Approaches
• Two group pretest/post-test designs
• Time series
• Post-test only
• Solomon three and four group
• Factorial
• Placebos
• Control groups

88. Sampling Techniques
Randomization
Systematic
Convenience
Stratifying

89. Informed ConsentInformed Consent
 Informed Consent is part ofInformed Consent is part of
examining the ethics of the researchexamining the ethics of the research
project as a whole.project as a whole.

90. Dental ResearchDental Research
BiostatisticsBiostatistics

91. Categorizing Data
• Discrete or Continuous
– Nominal
– Ordinal
– Interval
– Ratio

92. Descriptive Statistics
 Measures of Central Tendency
 Mean
 Median
 Mode
 Measures of Dispersion
 Range
 Variance
 Standard Deviation

93. The Normal Distribution
 Gaussian Distribution
 Bell-Shaped Curve
 Skewed Data

94. Graphing DataGraphing Data
 FrequencyFrequency
Distribution TableDistribution Table
 Grouped FrequencyGrouped Frequency
TableTable
 Bar GraphBar Graph
 HistogramHistogram
 PolygonPolygon 0
10
20
30
40
50
60
70
80
90
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East
West
North

95. Correlation
 Correlation
Coefficients
 Positive Correlation
 Negative
Correlation
 Strong Correlation

96. Correlation
 Pearson Product Movement Correlation
Coefficient
 Spearman Rank-Order Correlation
Coefficient

97. Statistical Decision MakingStatistical Decision Making
►ProbabilityProbability
►Type I ErrorType I Error
►Type II ErrorType II Error
►Degrees of FreedomDegrees of Freedom

98. Inferential StatisticsInferential Statistics
 Parametric Inferential StatisticsParametric Inferential Statistics
 Student t-testStudent t-test
 Analysis of VarianceAnalysis of Variance
 Nonparametric Inferential StatisticsNonparametric Inferential Statistics
 Chi Square TestChi Square Test
 Other Nonparametric TestsOther Nonparametric Tests

99. Interpretation of DataInterpretation of Data
 Statistical SignificanceStatistical Significance
 Clinical SignificanceClinical Significance

100. Research ResultsResearch Results
Validity: Results of the study can beValidity: Results of the study can be
inferred to the general population.inferred to the general population.
Reliability: The study was conducted inReliability: The study was conducted in
a controlled manner and if repeateda controlled manner and if repeated
would lend the same results; thus, thewould lend the same results; thus, the
study is reproducible.study is reproducible.

101. Evaluation ofEvaluation of
Scientific Literature and DentalScientific Literature and Dental
ProductsProducts

102. Regulation of Dental CareRegulation of Dental Care
ProductsProducts
Food and DrugFood and Drug
AdministrationAdministration
American DentalAmerican Dental
Association Seal ofAssociation Seal of
AcceptanceAcceptance

103. Dental Hygienist’s Role
Critical consumer
Patient education
Awareness of
advertising
techniques

104. Evaluation of Scientific
Literature
 Introduction
 Purpose
 Research Design
 Sample Selection
 Product Usage
 Examiners
 Statistical
Significance
 Results

105. Careers in
Dental Public Health

106. Positions for the RDHPositions for the RDH
U.S. PHSU.S. PHS
VA HospitalsVA Hospitals
Federal PrisonsFederal Prisons
Military Base ClinicsMilitary Base Clinics
Other AgenciesOther Agencies

107. United States RDH PositionsUnited States RDH Positions
 Commissioned OfficerCommissioned Officer
PositionsPositions
 Civil Service PositionsCivil Service Positions
 National Health ServiceNational Health Service
CorpsCorps

108. Other OptionsOther Options
 Independent ContractorIndependent Contractor
 Employee of Dental Staffing AgencyEmployee of Dental Staffing Agency
 Student OpportunitiesStudent Opportunities
 COSTEPCOSTEP

109. Strategies for Creating DentalStrategies for Creating Dental
Hygiene PositionsHygiene Positions
In Dental Public Health SettingsIn Dental Public Health Settings

110. PopulationsPopulations
HomeboundHomebound
InstitutionalizedInstitutionalized
Populations with DisabilitiesPopulations with Disabilities
Rural Area ResidentsRural Area Residents
Population with Dental PhobiasPopulation with Dental Phobias
Populations faced with Language orPopulations faced with Language or
Cultural BarriersCultural Barriers
Patients without FinancingPatients without Financing

111. Proposed Plan for ActionProposed Plan for Action
 Dental Hygiene Program Planning ParadigmDental Hygiene Program Planning Paradigm
 AssessmentAssessment
 Dental Hygiene DiagnosisDental Hygiene Diagnosis
 PlanningPlanning
 ImplementationImplementation
 EvaluationEvaluation

112. Practice Management Issues
 Patient tracking
 Appointment scheduling
 Practice promotion
 Collection of fees

113. Proposal Development andProposal Development and
PresentationPresentation
 IntroductionIntroduction
 Significance of PositionSignificance of Position
 Blueprint of theBlueprint of the
Operational ProgramOperational Program
 ConclusionConclusion
 ContractsContracts
 Teaching StrategiesTeaching Strategies

114. Cosmic Smiles PediatricCosmic Smiles Pediatric
DentistryDentistry
ReviewReview

115. Community Health/Research
Principles
Promoting health and
preventing disease
within groups
Participating in
community programs
Analyzing scientific
information, utilizing
statistical concepts,
and applying research
results

116. Cosmic Smiles PediatricCosmic Smiles Pediatric
DentistryDentistry PracticePractice
for the Dental Hygienist:for the Dental Hygienist:
““The Dental Hygienist is the PremierThe Dental Hygienist is the Premier
Dental Public Health Provider. “Dental Public Health Provider. “