Textbook of Preventive and Community Dentistry

PART 1: PUBLIC HEALTH

1 Concepts of Health and Disease and

Prevention, 3

Introduction, 3

Changing concepts of health, 3

Definitions of health, 4

Dimensions of health, 4

Concept of wellbeing, 5

Spectrum of health, 6

Determinants of health, 6

Responsibility for health, 7

Indicators of health, 8

Health service philosophies, 10

Strategies for the MDG, 13

Concept of disease, 14

Concept of causation, 14

Natural history of disease, 15

Disease classification, 17

Changing pattern of disease, 17

Community diagnosis and treatment, 17

Concepts of control, 17

Concepts of prevention, 18

Modes of intervention, 19

2 General Epidemiology, 22

Introduction, 22

Epidemiology and clinical medicine, 23

Scope of epidemiology, 23

Varieties of epidemiology, 23

The epidemiologic triad, 24

Measurements in epidemiology, 25

Epidemiological methods, 28

Analytical studies, 30

Association, relationship and causation, 33

Uses of epidemiology, 34

Screening for dental disease, 35

Investigation of an epidemic, 39

3 Environmental Health, 42

Definition of environmental health, 42

Components of environmental health, 42

General impact of environment on health, 42

Specific environmental health effects, 42

Methods of identifying environmental

pollution/contamination, 43

Differences between eradication, control and

elimination of environmental health

hazards, 43

POLLUTION CONTROL

Air pollution, 43

Noise pollution, 46

Water pollution, 49

SOLID WASTE MANAGEMENT

Introduction, 58

Disposal of wastes, 58

Solid wastes, 59

Occupational hazards associated with

waste handling, 64

Public education, 65

4 Health Education, 67

Introduction, 67

Definition, 67

Approaches to public health, 67

People participation in health

education, 68

Concepts of health education, 68

Nature of learning, 68

Principles of health education, 68

Levels of health education, 70

Methods of health education, 70

Types of communication, 74

Barriers to communication, 75

Planning and evaluation of health

education programme, 75

Health education and propaganda, 76

5 Primary Health Care, 78

Introduction, 78

Declaration of Alma Ata, 78

Primary health care, 80

Principles of primary health care, 80

Core activities, 81

Strategic imperatives, 81

Perceptions and commitment, 81

Problems with implementation of primary

health care, 82

Reasons for lack of implementation of primary

dental health care in India, 82

Primary health care in India, 82

Staffing pattern, 85

Functions of PHC, 86

6 National Health Programmes, 87

Introduction, 87

National health programmes in india, 88

Nutritional programme, 92

Pilot project on control of cardiovascular diseases

and stroke, 94

National programme for prevention and control

of diabetes, cardiovascular disease and

stroke (NPDCS), 95

7 International and National Health

Agencies, 97

Introduction, 97

Objectives, 97

Quarantine, 97

PAN American sanitary bureau (PASB 1902), 98

Office international d’hygiene publique (1907), 98

The health organization of the league of

nations (1923), 98

The united nations relief and rehabilitation

administration (UNRRA 1943), 99

International health agencies, 99

Indian voluntary health agencies, 111

8 Hospital Administration, 114

Introduction, 114

What is hospital administration?, 114

Services offered by the hospital, 115

Hospital as a system, 115

Hospital organization, 115

Categories of hospitals, 115

Human relation in hospitals, 118

Major areas of conflicts in hospital, 118

Quality assurance in health care, 118

Medicolegal aspects of hospital care, 119

9 Behavioural Sciences, 122

Introduction, 122

Definition, 122

Components, 122

Scope and use of behavioural science in

dental health, 122

Sociology, 123

Psychology, 124

Anthropology, 126

PART 2: DENTAL PUBLIC HEALTH

10 Introduction to Dental Public Health, 131

Introduction, 131

History of dentistry, 131

Definition of practice of dentistry, 134

Aims and objectives in planning dental care, 134

Scope of dental care, 134

Public health, 134

Dental public health, 136

Functions of public health dentist, 138

Roles of dental public health workers, 139

Achievements of dental public health

professional, 139

11 Epidemiology of Dental Caries, 141

Introduction, 141

Epidemiological studies, 141

Indian scenario, 142

Global scenario and current trends in

caries incidence, 142

Epidemiological factors of dental caries, 143

Host factors (demographic factors), 143

Agent factors, 146

Environmental factors, 146

12 Epidemiology of Periodontal Diseases, 148

Introduction, 148

Aetiology of periodontal disease, 148

Pathogenesis of periodontal disease, 152

Epidemiology of periodontal disease, 152

Epidemiologic studies, 152

National oral health survey and fluoride

mapping 2002–2003 (conducted by dental

council of India), 153

Epidemiologic factors, 154

13 Epidemiology of Oral Cancer, 157

Introduction, 157

Global scenario of oral cancer, 157

Spectrum of oral cancer in India, 158

Age distribution, 159

Gender distribution, 159

Ethnic basis, 159

Site distribution, 159

Trends, 159

Aetiology and risk factors, 160

Classification of oral cancer, 162

Clinical presentations of cancer of

oral mucosa, 163

Diagnosis of oral cancer, 164

Treatment of oral cancer, 164

Prevention and control of oral cancer, 164

Role of dentist in detecting and preventing

oral cancer, 168

Population-based cancer registries: invisible key

to cancer control, 168

14 Oral Health Education, 172

Introduction, 172

Considerations in oral health education, 172

Nature of learning, 173

Educational process, 174

One-to-one communication, 175

General educational theories, 176

Basic concepts of oral health education, 176

Approaches in oral health education and health

promotion, 180

15 Nutrition and Oral Health, 182

Introduction, 182

Nutrition, 182

Classification of nutrients, 182

Assessment of patient’s nutritional status, 187

Dietary history and evaluation, 187

Diet counselling and dietary advice, 188

16 Surveying and Oral Health Surveys, 190

SURVEYING

Introduction, 190

Steps in survey, 190

ORAL HEALTH SURVEYS

Pathfinder surveys, 194

Subgroups, 194

Index ages and age groups, 194

Number of subjects, 195

Organizing the survey, 195

Reliability and validity of data, 196

Implementing the survey, 196

Survey form, 196

17 Indices, 198

Introduction, 198

Definition of index, 198

Objective of an index, 198

Properties of an ideal index, 199

Purpose and uses of an index, 199

Selection of an index, 199

Types of indices, 200

18 Dental Auxiliaries, 222

Introduction, 222

Rationale for training and use of dental

auxiliary, 222

Definition, 223

Classification, 223

Effects of auxiliaries on dental education, 224

Dental manpower planning, 225

Benefits of using auxiliaries, 227

Impact of auxiliaries in Indian scenario, 227

19 Financing Dental Care, 229

Introduction, 229

Structure of dental practice, 229

Dental plan standards, 230

Classification of payment plans, 232

State children’s health insurance programme

(SCHIP), 238

Indian scenario, 238

20 Dental Needs and Resources, 241

Introduction, 241

Dental needs, 241

Demand for treatment, 243

Manpower, 243

Scope of service, 243

Matching programmes to need and demand, 244

21 Planning and Evaluation in Oral Health, 246

Introduction, 246

Types of health planning, 246

Planning of dental health services, 246

Planning for community dental programmes, 248

Rational planning model, 251

Evaluation, 251

Framework for programme evaluation in public

health, 253

22 School Dental Health Programmes, 257

Introduction, 257

Health promoting school, 257

Importance of oral health, 258

Importance of schools in promoting oral health, 258

Planning a school dental health programme, 259

Oral health education programmes, 261

School based preventive programmes, 264

Referral for dental care, 265

School lunch programme, 265

Incremental dental care, 266

Evaluation, 266

23 Dental Practice Management, 268

Introduction, 268

Factors associated with successful dental

practice, 26

24 Ethics in Dentistry, 272

Introduction, 272

Ethics and human conduct, 272

Ethics and social sciences, 272

Evolution of medical ethics, 273

Basis for medical ethics, 273

Principles of ethics, 274

Ethical rules for dentists prescribed by DCI, 275

25 Dentist Act—1948, 278

Introduction, 278

Effect of registration, 282

Miscellaneous, 283

The dentists (amendment) act, 1993, 285

26 Dental Council of India (DCI) and Indian

Dental Association (IDA), 288

COUNCIL

The dentists act, 1948, 288

Introductory, 288

Dental council of India, 289

The executive committee, 290

Recognition of dental qualification, 290

Qualification of dental hygienists, 291

Qualification of dental mechanics, 291

Qualification of dental hygienist, 291

Mode of declaration, 293

Preparation and maintenance of register, 294

The Indian Dental Association (IDA), 295

Management of the association, 296

27 Consumer Protection Act, 298

Introduction, 298

Supreme court decisions on the consumer

protection act, 299

Authorities for filing complaints based

on amounts of compensation, 300

Powers of consumer redressal forums

and commissions, 300

Who can sue the doctor under CPA?, 301

Against whom can a complaint be filed?, 301

Who are exempted?, 301

When the doctor can be sued?, 301

What you should do when you receive

a complaint?, 301

What is a complaint?, 302

Time limit to file a complaint, 302

Guidelines to be adopted to avoid needless

litigations, 302

Consent, 303

Salient features of consumer courts, 303

Consumer protection act and patients, 304

Consumer protection act and doctors, 304

Limitation of consumer forum, 304

28 Forensic Odontology, 306

Introduction, 306

History, 307

Common reasons for identification of found

human remains, 307

Principles of dental identification, 307

Dental identification, 308

PART 3: PREVENTIVE DENTISTRY

29 Introduction and Principles of Preventive

Dentistry, 317

Concepts of preventive dentistry, 320

Scope of preventive dentistry, 320

Principles of preventive dentistry, 320

30 Dental Caries, 321

Introduction, 321

Early theories of caries aetiology, 322

Current concepts of caries aetiology, 323

Clinical manifestations of dental caries process, 328

Caries of enamel, 330

Dentinal caries, 332

Root caries, 335

Microbiology of dental caries, 335

Mechanism of adherence of microorganisms to

tooth surface, 336

Formation of plaque, 336

Role of saliva in dental caries, 337

31 Diet and Dental Caries, 340

Introduction, 340

Food, 340

Diet, 340

Nutrition, 340

Components of foods, 340

Classification of carbohydrates, 341

Evidence linking diet and dental caries, 341

Cariogenicity of sucrose, 342

Stephan curve (1940), 343

Oral clearance of carbohydrates, 344

Preventive dietary programme, 344

Dietary counselling, 345

Tooth-friendly snack or ideal snack, 345

Sugar substitutes, 345

Functions of sugar in food technology, 346

Classification, 346

Difficulties in substitution of sucrose, 346

32 Caries Risk Assessment, 348

Introduction, 348

Risk group, 348

Factors relevant for assessment of caries risk, 349

Clinical evidence, 349

Identifying relevant risk factors, 349

Caries diagnosis, 350

33 Caries Activity Tests, 352

Introduction, 352

Caries activity tests, 352

Mutans group of streptococci screening tests, 354

Uses, 355

34 Cariogram, 357

Cariogram—the five sectors, 357

Chance to avoid caries, 358

Principles of caries risk estimation based on

"cariogram" concept, 358

Using the cariogram for evaluation of caries risk, 361

35 Dental Caries Vaccine, 363

Introduction, 363

Prospects for vaccination against dental caries, 364

Route of administration of vaccine, 365

Effective molecular targets for dental caries

vaccine, 365

Synthetic peptide vaccines, 366

Risk factors, 367

Past, present and future human applications, 367

36 Fluorides, 370

Introduction, 370

Water fluoridation, 371

Physiology and chemistry of fluoride, 373

Fluoride homeostasis, 373

Fluoride biomarkers, 376

Mechanism of action of fluoride, 377

Classification of fluoride therapy, 380

Dental fluorosis, 393

Defluoridation, 398

37 Fluoride Technology: A Global Perspective, 403

Global variation in exposure to fluoride, 403

Balancing benefits and risks of fluoride, 403

Water fluoridation globally, 404

Salt fluoridation in the world, 406

Milk fluoridation in the world, 406

Global fluoride toothpaste usage, 406

Inequality in oral health and fluoride policy, 407

Developing policy on fluoride, 409

38 Oral Hygiene Aids, 412

Introduction, 412

Manual toothbrush, 412

Powered toothbrushes, 415

Dental floss, 418

Interproximal and unitufted brushes, 419

Wooden or plastic triangular sticks, 420

Tongue cleaners, 421

Rinsing, 421

Irrigation devices, 422

Dentifrices and mouth rinses, 423

39 Pit and Fissure Sealants, 428

Introduction, 428

Definition, 429

Types of pit and fissure sealants, 429

A type of fissure sealant, 430

B type of fissures, 431

Patient and tooth selection, 432

Technique for sealant application, 432

Follow-up and review, 435

Minimally invasive preventive restorations

(preventive resin restoration—PRR), 435

Sealing of carious fissures, 436

Sealants versus amalgams, 436

Cost effectiveness of fissure sealants, 437

Sealant as part of a total preventive package, 437

Present status of pit and fissure sealants, 437

40 Atraumatic Restorative Treatment, 440

Introduction, 440

Principles, 440

Contraindications, 441

Rationale for application of ART, 441

Tips on working, 441

ART: important guidelines, 447

41 Minimal Invasive Dentistry (MID), 449

Introduction, 449

Definition, 449

Principles of minimally invasive dentistry, 449

Early caries detection, 450

42 Prevention of Dental Caries, 455

Introduction, 455

Caries preventive methods and means, 455

Dietary measures, 456

Oral hygiene measures, 458

Fluoride and different vehicles to provide

fluoride, 458

Antimicrobial agents and treatments, 460

Salivary stimulation, 461

Fissure sealants, 462

General recommendations for prevention of dental

caries with respect to use of sugars, 462

Recommendations (for children at high risk of

dental caries), 463

43 Prevention of Periodontal Diseases, 465

Introduction, 465

Implications for prevention, 465

Factors predisposing to plaque accumulation, 465

Oral hygiene aids, 468

Chemical plaque control, 469

44 Prevention of Malocclusion, 474

Introduction, 474

Aetiology of malocclusion, 474

Preventive measures, 476

Interceptive measures, 477

Scope and limitations of interceptive

orthodontics, 479

45 Prevention of Dental Trauma, 481

Introduction, 481

Primary protection, 482

Secondary prevention, 483

Tertiary prevention, 485

46 Occupational Hazards in Dentistry, 486

Introduction, 486

Occupational hazards, 486

Musculoskeletal disorders and diseases of

the PNS, 490

Recommendations, 490

Hospital waste management in dental

care setting, 490

47 Infection Control in Dental Care Setting, 493

Introduction, 493

Infection control procedures, 494

Disinfection and dental laboratory, 500

48 Evidence Based Dentistry, 502

How to search for the right evidence, 503

PART 4: RESEARCH METHODOLOGY

AND BIOSTATISTICS

49 Research Methodology, 507

Introduction to research, 507

Research methodology, 508

Research design and types, 508

Research questions and formulation

of hypotheses, 509

Ethical consideration in research, 509

Presenting results and basic nuances

of publishing, 509

50 Biostatistics, 511

Introduction, 511

Presentation of data, 511

Sampling techniques, 513

Statistical inference, 516

Correlation and regression, 517

APPENDICES

1 Definitions and Glossary, 521

2 Oral Health Assessment Proforma (1997), 532

3 Case History Proforma, 537

4 Levels of Prevention, 542

5 Tobacco use, Effects on Health and

Management, 544

6 Fluoride Facts, 551

Index,

553