Introduction to

Community Dentistry
and Dental Public Health

By: Dr. Anosha Riaz

AIM

 Understand various concepts of health; disease and illness

and factors affecting these states.
 Role of preventive dentistry in community health.
 Public health aspect of oral disease and disorders.
Learning Objectives:
By the end of this section the students would be able to learn

 They will get to know about the basic concepts of community and
dental public health.
 The knowledge and understanding of the concept of public health
and dental public health.
 Understand the determinants of health.
 Explain methods to eliminate inequalities in oral health.
 Comprehend the implications of dental public health in their
profession.
Definition:
 Community Dentistry, also called Dental Public Health
aims to educate students on the art and science of
preventing oral disease, promoting oral health and
improving the quality of life of the population with the
organized efforts of the society.
 It helps students to understand public health programs.
What is Community Medicine?

 The study of health and disease in the population

of defined communities, in order to identify their
health needs, and to plan, implement and evaluate
health programs to effectively meet these needs.
What is Health?

 “Absence of Disease” one of the oldest definition.

 Webster defined health as: “The condition of being sound
in body, mind or spirit, especially freedom from physical
disease or pain.”
 WHO defined health as “ a state of complete physical,
mental and social well-being and not merely an absence
of disease or infirmity.”
What is “Oral Health”?

 According to WHO:
“ Oral health is a state of being free from chronic
mouth and facial pain, oral and throat cancer, oral sores,
birth defects such as cleft lip and palate, periodontal (gum)
disease, tooth decay and tooth loss, and diseases and
disorders that affect the oral cavity”
Changing Concepts of Health:

1.Biomedical 2. Ecological
Concept Concept

3.Psychosocial 4. Holistic
Concept Concept
 Dimensions of Health:
1.Physical Dimension

2.Mental Dimension

3.Social Dimension

4.Spiritual Dimension

5.Emotional Dimension
Indicators of Health:
 Indicators are required not only to measure the health
status of a community, but also to compare the health
status of one country with that of another, assessment of
health care needs, for allocation of scarce resources, and
for monitoring and evaluation of health services, activities
and programs.
 Indicators help to measure the extent to which the
objectives and the targets of a program are being
attained.
Characteristics of Indicators:
Valid • should measure what they are supposed to measure .

• answer should be the same when measured by different people

Reliable in similar circumstances.

Sensitive • should be sensitive to the changes in the situation concerned.

Specific • should reflect changes only in the situation concerned.

Feasible • should have the ability to obtain data needed.

• should contribute to understanding of the phenomenon of

Relevant interest.
Classification of Indicators:
1. Mortality Indicators
2. Morbidity Indicators
3. Disability Rates
4. Nutritional Status Indicators
5. Health Care Delivery Indicators
6. Utilization Rates
7. Indicators of Social and Mental Health
8. Environmental Indicators
9. Socioeconomic Indicators
10. Health Policy Indicators
11. Indication of quality of life
12. Other Indicators
1.Mortality Indicators:
“A set of indicators measuring the rate of mortality related to age, sex,
infectious disease, injury, cancer, and chronic disease conditions.” These are as follows:

 Crude death rate: “No. of deaths per 1000 population per year in a
given community.”
 Expectation of life: “Average no. of years that will be lived by those
born alive in a population.” or “Life expectancy at birth.”
 Infant Mortality Rate: “Ratio of deaths under 1 year of age in a
given year to the total no. of live births in the same year, usually
expressed as a rate per 1000 live births.”
 Child Mortality Rate: “No. of deaths at age 1-4 years in a given year
per 1000 children in the age group at the midpoint of the year
concerned.”
Few other Mortality Indicators:

Under 5
Maternal
proportionate
Mortality Rate
mortality rate

Disease
Proportional
Specific
Mortality Rate
Mortality Rate
2.Morbidity Indicators:
“A morbidity indicator is a value describing the presence of disease in a population, or the degree of risk of an event.”

The following morbidity rates are used to assess ill health in a community;

Admission, Spells of
Attendance
Incidence Readmission Duration of sickness or
Notification rates at
and and stay in a absence from
Rates OPDs, health
Prevalence Discharge hospital work or
centres, etc
rates school
3.Disability Rates:
The commonly used disability rates fall into two
groups:
A) Event Type Indicators
B) Person Type Indicators

Sullivan’s Index:
This index is computed by subtracting from the
life expectancy the probable duration of bed disability and
inability to perform major activities, according to cross-
sectional data from the population surveys.
4.Nutritional Status Indicators:
- Anthropometric measurement of pre-school children
- Heights of children at school entry
- Prevalence of low birth weight

5.Health Care Delivery Indicators:

- Doctor-population ratio
- Doctor-nurse ratio
- Population-bed ratio
- Population per health/subcentre
- Population per traditional birth attendant
6.Utilization Rates:
Utilization of services or actual coverage is expressed as the proportion of
people in need of a service who actually receive it in a given period, usually a year.

7.Indicators of Social and Mental Health:

- Suicide
- Homicide
- Acts of violence and crimes
- Road Traffic accidents
- Alcohol and Drug abuse
- Consumption of tranquilizers
- Smoking
- Obesity
8.Environmental Indicators:
They reflect the quality of physical and biological environment in
which diseases occur and in which the people live. They include:
 Air, water and noise pollution
 Radiation
 Solid wastes
 Exposure to toxic substances in food and drinks.

9.Socioeconomic Indicators:
 Rate of population increase
 Level of unemployment
 Family size
10.Health Policy Indicators:
The single most important indicator of political commitment is
“Allocation of adequate resources.”
11.Indicators of quality of life:
 Infant Mortality
 Life expectancy at age one
 Literacy

12.Others:
 Social Indicators
 Basic needs indicators
 Health for all indicators
 What is DISEASE?
 Webster defined disease as:
“A condition in which body’s health is impaired, a
departure from state of health, an alteration of the human
body interrupting the performance if vital functions.”
 Other definition:
“Any deviation from normal functioning or state of
complete physical or mental well-being.”
 Iceberg of Disease:
 According to this concept, disease in a community may be compared with an
iceberg
 The tip represents:
Clinical Cases (What the physician sees
in the community)
 The submerged portion represents:
Hidden mass of the disease,
Latent, inapparent, pre-symptomatic and
undiagnosed cases and carriers in the community
Concepts of Causation/Etiological
Concepts:
 Germ Theory of disease:
The concept in the germ theory of disease is generally
referred to as “one-to-one relationship between causal agent and
disease.” Disease
Man Disease
agent
The disease model is:

 This concept emphasizes to “Microbes as sole cause of disease”

 It is now recognized that a disease is rarely caused by a single
agent alone, but rather depends upon a number of factors, which
contribute to its occurrence.
Epidemiological Triad:
The causative factors may be classified as
“Agent, Host and environment.”
These three factors are referred as epidemiological triad. Interaction of these factors is
required to initiate the disease process in man.
 Agent Factors:
Agent is defined as a substances, living or non-
living, or a force, the excessive presence or relative lack of
which may initiate or perpetuate a disease process.
 Host Factors:
Host is defined as a person or other animal,
including birds and arthropods that affords subsistence or
lodgment to an infectious agent under natural conditions.
 Environmental Factors:
Environment is man’s external surroundings.
Agent Factors
• Biological agents:
Virus, bacteria, fungi,
protozoa, etc
• Nutritional agents:
Proteins, fats, vitamins,
carbohydrates,
• Physical agents:
Heat, cold, humidity,
pressure, radiation
• Chemical agents:
Endogenous
Exogenous
• Mechanical agents:
Chronic friction,
mechanical forces
• Social agents:
Smoking,
Host Factors Environmental
Factors
• Demographic • Physical environment:
factors: Non-living and physical
age, gender factors with which man is in
• Biological factors: constant interaction like air,
genetic factors water, soil, climate, etc
• Social & Economic • Biological environment:
factors: Living things which
education, surround man including man
occupation, marital himself
status • Psychosocial
• Lifestyle factors: environment:
personality traits, Factors affecting personal
living habits, physical health, health care and
exercises. community well-being
Multifactorial Causation:
This concept emphasizes that diseases can’t be explained on the basis of germ theory
of disease, they are linked with multiple factors, for example: Coronary heart disease depends
upon multiple factors like fat intake, smoking, lack of physical exercise, and obesity.

Web of Causation:
 It considers all the pre-disposing factors of any kind and
their complex interactions with each other.
 Sometimes removal or elimination of just one link or chain
may be sufficient to control disease, provided that the link
is sufficiently
Screening for Diseases:
Screening is defined as “ The search for unrecognized disease or defect by means of
rapidly applied tests, examinations or other procedures in apparently healthy individuals”

 Criteria for Screening:

Criteria for screening is based on two considerations:
a. The disease to be screened
b. The test to be applied
 Aim & Objective of screening:
The basic purpose of screening is to sort out from a large
group of apparently healthy persons those likely to have the disease or
at increased risk of the disease under study, to bring those who are
“apparently abnormal” under medical supervision and treatment.
Disease to be screened should fulfill following
criteria:
• The condition sought
• Latent or early asymptomatic stage
• The natural history of condition
• Facilities available to confirm diagnosis
• Effective treatment
• Policy to treat
“Early detection and treatment reduces morbidity and
mortality”
Criteria of Screening Test:
The screening test must satisfy the criteria of:

Acceptability

Repeatability

Validity (Accuracy)
Uses of Screening:

Case Control of
Detection Disease

Research Educational
Purposes opportunities
 Infection
Definition:
“The entry and development or
multiplication of an infectious agent in the
body of man or animals”
 Modes of Transmission of Infection:
Direct Transmission
1. Direct Contact
2. Droplet Infection
3. Contact with soil
4. Inoculation with skin or
mucosa
5. Transplacental
Indirect Transmission
1. Vehicle-Borne
2. Vector-Borne
a. Mechanical
b. Biological
3. Air-Borne
a. Droplet nuclei
b. Dust
4. Fomite-Borne
5. Unclean hands and fingers
 Stages of Infectious Disease:
1. Incubation Period
The time interval b/w invasion by an
infectious agent and appearance of
first sign or symptom of the disease
2. The Onset or Prodromal
stage
This commences when the first symptoms
appear and continue until the condition is
well developed

3.The Period of advance or 5. Period of

Fastigium 4. Period of Defervescence Convalescence
All the symptoms are now All the symptoms are The patient has overcome
increasing in severity until a decreasing in severity completely the invaders and
climax is reached toxins
 Specific Defenses of Human Body:

• Humoral Immunity
Active • Cellular Immunity
Immunity

• Normal Human Ig
Passive • Specific Human Ig
Immunity • Animal antitoxin or antisera
Thank You!
Any Questions