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Part 2 book “A textbook of public health dentistry” has contents: Planning and evaluation, plaque control, dental plaque, caries risk assessment, caries activity tests, fluorides in dentistry, dental caries vaccine, pit and fissure sealants, prevention of periodontal disease, child psychology, forensic dentistry,… and other contents.
20 Planning and Evaluation CM Marya Program planning is an organized process to address the needs of a specific group of people Program planning involves a process which is to design, implement and evaluate a clinic or community-based project Planning is an integral part of dental care provision that operates at many different levels, i.e national level, at health authority level and with in a dental practice where dental practitioner and their team members may develop a range of practice policies aimed at improving the services provided The benefit of program planning is that everyone involved in the project can make rational choices based on relevant information, previous experiences, and community preferences Careful planning before a project begins, and can make a significant impact on the success of the project DEFINITION EC Banfield defines plan as “it is a decision about a course of action” PURPOSE OF PLANNING A To match the limited resources with many problems B To eliminate wasteful expenditures or duplication of expenditures C To develop the best course of action, to accomplish a defined objective USES OF PLANNING It helps to be proactive in decision-making rather than constantly reacting to pressures and demand It enables priorities to be set It identifies where resources can be directed to have the greatest impact First Steps Identify the overall issue or concern Establish a committee/task force Identify the overall goal What are Goals? Goals are typically broad, sweeping statements which provide a long-term vision for the outcome of the project Goals should be in agreement with the organization’s mission They should also be achievable within the organization’s scope Goals are not specific; they not specify the methods that will be used or the degree of improvement expected (Table 20.1) A well written goal should be simple, brief and consist of: • Who is affected, and • What change will occur as a result of the program Table 20.1: Goals vs objectives Goals Objectives Broad statement Specific, limited in scope Remains stable over the course of the project Change as needs of the population or community evolve Identifies the long range purpose of the project Identifies a measurable outcome of the project PLANNING CYCLE It involves following steps (Fig 20.1): Need assessment Identifying priorities Developing aims and objectives Assessment of resources Implementation Evaluation Need Assessment This is done for identification of oral health problems and concerns of the population It helps to: a Define the problem and to identify its extent and severity Chapter 20 Planning and Evaluation 237 With limited resources it becomes necessary to set priorities to allow the most efficient allocation of resources High risk dental need groups include: • Pre-school and school going children • Elderly persons • Physically/mentally handicapped person • Medically comprised person Developing Aims and Objectives Aim is the over all goal to be achieved, where as Objectives are the steps needed to reach the aims The World Health Organization defines objective as: “The end result of a program, a project or an institution seeks to achieve A specific end point, condition or situation one is determined to achieve” Benefits of Objectives Fig 20.1: The planning cycle b Obtain a profile of the community to know the causes of the problem c Develop appropriate goals and objectives for solving the problem d Evaluate the effectiveness of the preventive programs by providing baseline information and comparing progress achieved in solving the problem over a period of time It involves: • Collection of oral health status related This can be done by various techniques such as survey questionnaires, clinical examinations or through personal communication • Evaluation of existing dental health programs and their success • Gathering information regarding personnel, facilities, resources and funds available • Knowing social and cultural factors that may affect the outcome of the program • Knowing the educational status of the community Identifying Priorities It is agreeing on the target areas for action Its priorities are not determined, the program may not serve those individuals or groups who need the care most It includes: • Finding out the problem that affects a large number of people • More serious problem should be given priority • Objectives will provide the framework for the project by setting benchmarks for success • Objectives are specific actions to achieve “The Goal” Objectives provide clarity to the team of expected results In setting objectives time and resources are important factors They are not only a guide to action but also help to measure work after it is done Objectives may be short-term or long-term “SMART” Acronym in Setting Objectives • S – Specific – the objective must be specific to the problem identified • M – Measurable – the objective must be measurable by available data sources • A – Attainable – the objective must be attainable Keep it simple and easily attainable • R – Relevant – the objective must be relevant to the community and based on evidence For example, as caries prevalence usually does not dramatically decrease in a short period of time, an objective to reduce caries prevalence by 8% in a one year period would not be realistic Instead, reducing prevalence by 2% in a twoyear span might be more appropriate, or reducing incidence (new cases) by 10% in a two-year period might be possible • T – Timely – the objective should have a definitive timetable, such as reducing caries prevalence by X% in a specific period of time Objectives are more specific and they describe: • What: is to be attained • Who: for whom it is to be attained • Extent: or magnitude of the situation to be attained • Where and when: the exact location and time of the program 238 Section Dental Public Health Assessing Resources and Constraints Evaluation It includes identifying the range of resources available to facilitate implementation of the plan, e.g personnel, materials and equipments Resources must be identified for each objective and activity In either case, organizers must take care to ensure adequate resources are available to carry out the activities that will accomplish the objectives of the plan Evaluation means measuring the changes resulting from the plan This requires monitoring It is a continuous process; an observation, recording and reporting of how well the program is meeting its stated objectives Evaluation measures the progress and effectiveness of each activity The classic planning cycle may be summarized in a simple Problem, Objective, Activities, Resources, and Evaluation (POARE) format This format provides an easy, step-bystep process to organize and evaluate the project (Fig 20.2) What is Included in Resources • • • • • • • Personnel Space Time Supplies Travel Financial need In-kind contribution Constraints These are the road blocks or obstacles to achieving a certain goal or objectives If these obstacles are identified early in the planning then the program can be modified accordingly Constraints may result from: • Resources limitation • Governmental policies • Inadequate transport system • Labor shortage • Inadequate facilities • Community’s socioeconomic, cultural and educational characteristic P Problem • Determine the extent of the problem • Collect relevant information • Determine community support • Gather baseline data O Objectives • State SMART objectives • May be formative, process, or impact • May be short-term or long-term • Identify target populations A Activities • Outline methods that will achieve objectives • Only PROVEN strategies should be used • Identify barriers and strategies to overcome those barriers R Resources • Identify personnel, supplies, other financial needs, time, space, travel, or in-kind contributions E Evaluation • Implementation and evaluation may be simultaneous • Plan how objectives will be evaluated • Qualitative methods may be used to explain “why” or “how” something happened • Use information to revise objectives Alternative Strategies Once the constraints are known the planner should consider alternative course of action to achieve objectives with the available resources The more the number of alternative strategies the better it is Out of many the planner can select the best possible strategy Implementation It is turning the plan into action Planner must know each specific activity to be done to develop an implementation strategy Consideration should be given to: • Definition of roles and tasks • Materials, media, methods and techniques to be used • Selection, training, motivation and supervision of the manpower involved • Chronological sequence of activities • Organization and communication Many short-comings often appear at this stage Plan execution depends upon the existence of effective organization Fig 20.2: Poare format EVALUATION Evaluation may be defined as an investigation into the performance of a programme in terms of its success or failure to achieve stated aims Green (1977) has given a broader view of evaluation and defines it as ‘the comparison of an object of interest against a standard acceptability’ The definition implies that not only the outcome of a program should be monitored but also how it is used Purpose of Evaluation To ensure that a program is fulfilling its purpose Types of Evaluation Evaluation may take one of two forms: • Formative – Implementation – Process Chapter 20 Planning and Evaluation • Summative – Impact or also known as outcome There are two broad types of evaluation Formative Evaluation It focuses on the factors involved in the implementation of the program It ensures monitoring and improving the day to day activities of the program It is usually carried out to aid in the development of a program in its early phases It helps the developers to assess the performance of the programme and help decide whether changes should be made to improve program activities It is done at several points in the developmental life of a project and its activities Implementation Evaluation Assess whether the project is being conducted as planned Example: Was appropriate number of staff available for seeing patients in the casualty room? Progress Evaluation • Assess progress in meeting the goals • It involves collecting information to learn whether or not the benchmarks of participant progress were met and to point out unexpected developments Example: Are patients moving toward the anticipated goals of the project? Summative Evaluation It concentrates on collecting information once the program has finished The aim of summative evaluation is not to influence the outcome of a program but to record failure or success in terms of stated aims and objectives Evaluation Methods Quantitative • Most evaluation is quantitative in nature, as most evaluation measures the extent to which the objectives were met • Numerical data is useful for future planning of resources • Quantitative evaluation does not inform organizers why the program was a success or failure For example, a survey may reveal how satisfied participants were with the program, but not why they were satisfied or how the program could be improved Methods of Quantitative Evaluation • Computer searches • • • • • 239 Chart reviews Epidemiologic data Demographic data Surveys Screenings Qualitative • Interviews with providers, program participants, or community members may divulge strengths or weaknesses in the program that can be used for future planning • Observations done during the program can identify problems with program flow, other services that could be incorporated, or reasons for participant satisfaction or dissatisfaction When using qualitative techniques such as observations or unstructured interviews • Focus groups acknowledge the participants’ perspectives are meaningful and valuable • Checklist of desired topics will ensure relevant information is gained The list could contain roughly worded questions that can be paraphrased and/or points to cover in the interviews or observations Methods of Qualitative Evaluation • Interviews • Focus groups • Observations • Key informant interviews REASONS FOR EVALUATION The main reason for evaluation of a programme is to assess the results of expending human and economic resources in a particular way This helps to: • Decide whether the program be continued in its present form • To determine that the program is having the desired effect • Assess proper use of resources • Improve the procedures (can show that a simpler approach may be equally effective) Four criteria that have been accepted for evaluation of dental services include: Effectiveness: If the stated objectives were achieved or not Efficiency: What was the cost of manpower or finance in relation to the output of the program Appropriateness: If the program is acceptable to both community and providers and the priorities reflect a proper interpretation of the needs of the population? Adequacy: Was the intended coverage of the target population achieved 21 School Dental Health Programs CM Marya Schools provide an important setting for promoting health, as they reach over billion children worldwide and, through them, the school staff, families and the community as a whole Health promotion messages can be reinforced throughout the most influential stages of children’s lives, enabling them to develop lifelong sustainable attitudes and skills Poor oral health can have a detrimental effect on children’s quality of life, their performance at school and their success in later life School health services contribute to goals of both the education system and the health care system Coordinated school health programs offer the opportunity to provide the services and knowledge necessary to enable children to be productive learners and to develop the skills to make health decisions for the rest of their lives One proven strategy for reaching children at high-risk for dental disease is providing oral and dental health services in school-based health centers… supporting linkages with health care professionals and other dental partners in the community MODELS Throughout the evolution of school health, many different models have been used to delineate the components of school health programs THE THREE-COMPONENT MODEL This model originated in the early 1900s and evolved through the late 1980s Considered the traditional model of school health, it consists of the following components: (1) health education, (2) health services, and (3) a healthful environment THE EIGHT-COMPONENT MODEL In the late 1980s the three-component model was replaced by the eight-component model Also known as the model for a “Comprehensive School Health Program”, it consists of eight elements The Comprehensive (Coordinated) School Health Program (CSHP) model includes the following components (Fig 21.1): Health Education: A planned sequential kindergarten through grade 12 curriculum that addresses the physical, mental, emotional, and social dimensions of health; Physical Education that can serve as a means for maintaining cardiovascular and respiratory efficiency, as well as method of self expression, stress relief, and social development; School Health Services that promote the health of students through Preventive services, education, emergency care, referral and management of acute and chronic health conditions It is designed to promote the health of students, identify and prevent health problems and injuries, and ensure care for students Nutrition Services: School nutrition services include integration of nutritious, affordable and appealing meals, nutrition education, and an environment that promotes healthy eating behaviors for all children Designed to maximize each child’s education and health potential for a lifetime School Counseling, Psychological and Social Services Activities that focus on cognitive, emotional, behavioral, and social needs of individuals, groups and families Activities capable of intervening in areas of assertiveness training, life skills training, peer interaction, problem solving, self esteem, and adolescent rebellion Healthy School Environment focusing on both physiological and psychological surroundings in which students and school personnel are expected to work; School Site Health Promotion to support educators and staff that become interested in improving their own health, thus becoming powerful role models School and Parent/Community Involvement that establishes and promotes collaborative efforts not only within school but with parents, business, and others interested in the health outcomes of students Chapter 21 School Dental Health Programs 241 that take place in schools and their surrounding communities.” The approach is designed to affect not only individual health behaviors, but also to improve the environments where young people live and learn Comprehensive School Health Education is an instructional plan to provide young people and their families with critical health information and skills that will encourage positive health behaviors Comprehensive School Health Education is most effective when it: • Provides developmentally appropriate, sequential, comprehensive health education lessons at each grade level • Addresses all of the critical health areas that put children and youth most at risk • Is aligned to health education standards and content expectations • Assesses students’ level of health knowledge and skills • Implemented with all students • Involves families and communities • Provides professional development to help teachers stay current on legislation, health content, curriculum, and teaching strategies Fig 21.1: Components of school health programs DEFINITION Suggested core health services every school should provide: The essential services include: • Screening, diagnostic, treatment and health counseling services; • Referrals and linkages with other community providers; and • Health promotion and injury and disease prevention education The WHO Global School Health Initiative consists of four broad strategies: • Building capacity to advocate for improved school health programs • Creating networks and alliances for the development of Health Promoting Schools • Strengthening national capacity • Research to improve school health programs, health and education of young people, and individual documents in the series encourage schools to address one or more important health issues SCHOOL-BASED HEALTH CENTERS, IN PARTNERSHIP WITH COMMUNITY DENTAL PROVIDERS, CAN: • • • Enhance education Enhance dental service Eliminate barriers to dental care Comprehensive School Health Education Comprehensive School Health (CSH) is defined as “a broad spectrum of programs, policies, activities and services There are a variety of definitions used to explain school health programs The following definition of a comprehensive school health program was established by the Institute of Medicine Committee on Comprehensive School Health Programs in Grades K-12 A comprehensive school health program is an integrated set of planned, sequential, school-affiliated strategies, activities, and services designed to promote the optimal physical, emotional, social, and educational development of students The program involves and is supportive of families and is determined by the local community based on community needs, resources, standards, and requirements It is coordinated by a multidisciplinary team and accountable to the community for program quality and effectiveness Terminology: Comprehensive Versus Coordinated The terms “comprehensive” and “coordinated” school health are used frequently in school health literature • Comprehensive: Comprehensive means inclusive, covering completely and broadly, and refers to a broad range of components It should be emphasized, however, that programs and services actually delivered at the school site may not provide coverage by themselves but are intended to work with and complement the efforts of families, primary sources of health care, and other heath and social service resources in the community to produce a continuous and complete system to promote and protect students’ health 242 Section Dental Public Health • Coordinated: Coordinated means brought into combined action to cause separate elements to function in a smooth concerted manner Coordination implies a formal relationship and blurring of boundaries between coordinating partners, although partners can still retain identity and affiliation to their profession Four Goals of Comprehensive School Health: To promote health and wellness To prevent specific diseases, disorders and injury To intervene to assist children who are in need or at risk To help support those who are already experiencing poor health HEALTH PROMOTING SCHOOLS The health promoting school is “a place where all members of the school community work together to provide students with integrated and positive experiences and structures which promote their health” (WHO 1996) Developing a health promoting school means building healthy public policy, creating supportive school environments, strengthening community participation in school programming, developing personal health decision-making skills, and reorienting school health services to focus on prevention At the conceptual heart of the health promoting school is the concept of health promotion which according to the World Health Organization’s Ottawa Charter for Health Promotion (1986) is:”the process of enabling people to increase control over, and to improve their health To reach a state of complete physical, mental and social well-being, an individual and group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope up with the environment Health is, therefore, seen as a resource for everyday life, not the object of living Health is a positive concept emphasizing social and personal resources, as well as physical capacities Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing.” School is the first formal opportunity, children have to systematically explore health concerns in the company of their peers while under the supervision of a professional educator Schools offer a very large proportion of the population access to a professional workforce of teachers educating children and youth at a critical age and stage of development Aim of School Dental Services American Dental Association (ADA) describes them as: To help every school child appreciates the relationship of dental health to general health and appearance To encourage the observance of dental health practices, including personal care, professional care, proper diet and oral habits To enlist the aid of all groups and agencies interested in the promotion of school health To correlate dental health activities with the total school health programs To stimulate the development of resources to make dental care available to all children and youths To stimulate dentists to perform adequate health services for children The WHO Oral Health Program has prepared an oral health technical document to strengthen the implementation of an oral health component of the Health Promoting Schools program Reasons for oral health promotion through schools are: • Pupils and students can be accessed during their formative years, from childhood to adolescence These are important stages in people’s lives when lifelong oral health related behaviour as well as beliefs and attitudes are being developed • The schools can provide a supportive environment for promoting oral health Access to safe water, for example, may allow for general and oral hygiene programs Also, a safe physical environment in schools can help reduce the risk of accidents and concomitant dental trauma • The burden of oral disease in children is significant Most established oral diseases are irreversible, will last for a lifetime and have impact on quality of life and general health • School policies, the physical environment and education for health are essential for attainment of oral health and control of risk behaviors, such as intake of sugary foods and drinks, tobacco use and alcohol consumption • Schools can provide a platform for provision of oral health care, i.e preventive and curative services In the USA School Dental Health programs are highly promoted because of the following reasons: • Dental caries is one of the most common chronic childhood diseases — times more common than asthma and times more common than hay fever • Children living in poverty suffer twice as much tooth decay as their more affluent peers, and their disease is more likely to be untreated • Fluoridation is the most effective way to prevent dental caries but more than 100 million Americans not have an optimally fluoridated water supply • Over 80 percent of tooth decay in school children is on chewing surfaces of teeth that dental sealants can protect but only 18.5 percent of children and adolescents have at least one sealed permanent tooth • 25 percent of children living in poverty have not seen a dentist before entering kindergarten • 23 million children are without dental insurance coverage Uninsured children are 2.5 times less likely than insured children to receive dental care Chapter 21 School Dental Health Programs OBJECTIVES OF SCHOOL BASED DENTAL HEALTH PROGRAM • Increase the proportion of children who use the oral health system each year • Increase the proportion of school-based health centers with an oral health component • Increase the proportion of low-income children and adolescents who receive preventive dental services each year • Reduce the prevalence of children and adolescents with untreated dental decay • Reduce the proportion of children and adolescents who have dental caries in their primary or permanent teeth PARTNERS IN SCHOOL ORAL HEALTH PROGRAMS Various groups and organizations can play an active role in oral health programs in school Their coordinated efforts can lead to a successful oral health program The dental schools, the school personnel and various organizations can be important partners in this program (Fig 21.2) Contribution from the city health department and the policy makers can influence the positive outcome of such a program School-based preventive programs include: SELF-APPLIED FLUORIDES School-based fluoride mouthrinse programs, fluoride tablet programs, and supervised toothbrushing with a fluoride dentifrice are effective ways of delivering the benefits of fluoride to school-aged children Cost-effectiveness should be determined based upon the caries rates of the children in the community 243 The safety of fluoride mouthrinse and tablet programs is an important consideration All personnel mixing and dispensing fluoride should participate in regular training sessions to review proper handling procedures Fluoride must be stored in a secure place and distribution of mouthrinse and tablets should be monitored School Fluoride Mouth Rinsing Program Fluoride mouth rinsing program are advised for grades to 12 but not below as many younger children cannot master the technique of swishing without swallowing For kindergarten children plain water can be used as an educational program A once-a-week mouth rinse can result in an approximate 20 to 40 percent reduction in dental caries School Fluoride Tablet Program Fluoride tablet programs are easier to carry out in school classroom Every student is given one 2.2 mg sodium fluoride (1 mg fluoride) tablet which is chewed, swished around the mouth for minute and then swallowed This swish- and swallow technique provides the benefits of a topical application (as with mouth rinse) and also provides optimum systemic benefit during the period of tooth development Classroom Tooth Brushing The daily brushing of teeth in classroom may be an ideal method of plaque control but it is an impractical reality Toothbrushing using a fluoride dentifrice is beneficial in reducing caries incidence rather than toothbrushing alone Unfortunately usually the focus is on toothbrushing alone and not on the fluoride Another problem faced is that toothbrushing is usually taught for a few weeks or months and then stopped much before the habit pattern is developed During this time there should be major emphasis on the reasons for using a fluoride dentifrice when brushing Most classrooms don’t have a water supply and the sinks for classroom brushing The daily storage and continual replacement of worn-out and lost brushes is another problem SCHOOL BASED SEALANT PROGRAM Fig 21.2: Partners in school oral health program School-based or school-linked dental sealant delivery programs provide sealants to children unlikely to receive them otherwise The placement procedure for the sealants is rapid and painless They are highly effective in protecting the occlusal pits and fissures Such programs define a target population within a school district; verify unmet need for sealants; get financial, material, and policy support; apply rules for selecting schools and students; enroll students at school; and apply sealants at school or offsite in clinics Many programs target what are referred to as high-risk children High-risk children include vulnerable populations less likely to receive private dental care • Target grades are often selected for school sealant programs Children in grades 1, 2, and should be 244 Section Dental Public Health screened, as they are most likely to have newly-erupted molars that meet the criteria for sealant placement However, in communities with high caries rates, it is preferable to see all grades each year to evaluate retention of sealants, teeth needing sealants, and referral for decay • Portable dental equipment is effective for sealant placement and can be brought to the school site If transportation is available, children can be taken to the clinic for sealant placement • Sealants provided in a school setting are reported as Level II clinical services These programs generally enhance the clinical dental program It is important for programs not to view sealants as a one-time event for life Sealants, like other restorations, need to be monitored SCHOOL WATER FLUORIDATION School water fluoridation is recommended only if the students are coming from the areas which have low fluoride content Consolidated rural school is ideal for this approach, since all students from kindergarten to high school are housed in the same building The recommended concentration for school water fluoridation program is 4.5 ppm, in contrast to ppm for community water supply due to belated and abbreviated exposure to fluoridated water in schools Studies have shown approximately 40% reduction in dental caries due to school water fluoridation Major concerns about school water fluoridation are: Installation cost is very high Some custodial and backup personnel must be rained and used for continual operation, maintenance and monitoring of the unit By age 6, all teeth except the 3rd molars are in advanced stage of mineralization, thus reducing the pre-eruptive benefits of fluoride TOPICAL FLUORIDE APPLICATION PROGRAM Children accessing the dental services via school sealant programs can be provided with topical fluoride according to the needs of the individual child Target those children with new smooth-surface caries, a history of high caries, or handicapped conditions for APF topical procedures ORAL HEALTH EDUCATION Determine if the health education curricula used by the schools in the service area have oral health components Schools often welcome assistance from dental professionals when evaluating materials Visits by dental providers to the classroom build good public relations The Service Unit Dental Program can assist in the implementation of oral health education programs that address topics of particular concern to American Indian/Alaska Native populations, such as: • Prevention and cessation of smokeless tobacco use and smoking • Prevention/treatment of rapidly progressing periodontal disease • Prevention of Baby Bottle Tooth Decay/Early Childhood Caries (BBTD/ECC) Classroom instruction by itself should not be expected to influence individuals’ behavior such that a group’s oral health status improves However, the value of classroom instruction should not be discounted It is important that people have sufficient and accurate information about oral disease prevention to make informed decisions regarding personal and community oral health promotion measures as given in Fig 21.2 CONSIDERATIONS IN IMPLEMENTING A SCHOOL-BASED DENTAL PROGRAM • • • • • • • • • • Staff recruitment and retention Sustainability –establishing a collaborative business plan Electrical capacity- “dedicated line” for dental equipment Potential use of portable equipment AC/fans for temperature sensitive equipment Availability of X-ray machine- if unavailable, then referral service required Emphasis on skills training for long-term oral health maintenance Securing parent involvement for follow-up and family awareness Securing support from dental school and oral health organizations Securing support from local health providers involved in providing dental care to underserved populations GUIDELINES FOR AN IDEAL SCHOOL DENTAL PROGRAM A • • • comprehensive school dental program should: Be available to all children Be feasible and administratively sound Provide facts about dental health and dental care focusing mainly on self care preventive procedures • Help in the development of positive attitude towards dental health • Provide an environment for development of skills and technique necessary for maintenance of oral hygiene for example tooth brushing and flossing • Include primary preventive dentistry procedures e.g prophylaxis, pit and fissure sealants, topical fluoride application • Have screening program for early identification, referral and treatment of identified lesions The American Academy of Family Physicians (AAFP) and the American Academy of Pediatric Dentistry (AAPD) recommends that infants be scheduled for a first dental visit within six months of the eruption of the first primary tooth but not later than 12 months of age A school health program should include: Dental screening: Dental screening is an opportunity to detect early dental or oral health problems Chapter 21 School Dental Health Programs Screening is not a replacement for a complete examination in a dentist’s office However, dental screening can be an important component of an oral health program and an important element of a school health program The screening should look for the presence of dental caries (tooth decay), periodontal disease (inflammation of gums and supporting structures), malocclusion (irregularity of the teeth or jaw), and trauma from oral injuries Dental Health Education The schools can promote good oral health and prevent oral problems by educating students and parents Oral health education should focus on: • Prevention of decay through proper methods of oral hygiene (e.g brushing, flossing); • Use of fluoride or fluoridated water; • Good nutrition including restricting candy and soft drinks; and • The importance of using mouth-guards in organized high body-contact sports Referrals and Follow-up Care The screening should look for the presence of dental caries (tooth decay), periodontal disease (inflammation of gums and supporting structures), malocclusion (irregularity of the teeth or jaw), and trauma from oral injuries All children complaining of oral pain, with obvious dental caries, or mild 245 GUIDELINES FOR SCHOOL-BASED DENTAL PREVENTION PROGRAMS School-based dental prevention programs should address the following areas: Assess disease burden in the population served and school’s needs • Select population-targeting method (reduced and free lunch programs, etc.) • Target program based on risk of disease • Target school and participants according to economic need Deliver dental preventive services including oral hygiene instructions, oral prophylaxis, topical fluoride (gel or varnish), the application of dental sealant, and dental radiographs (if possible) Increase education efforts for individual and community awareness of the importance of oral health and the benefits of dental sealants Referral to and follow-up with community dentists for definitive restorative care • Follow-up with school nurse to evaluate number of referrals completed • Follow-up with local health department for compliance issues and outreach efforts Quality Assurance program including follow-up gum disease should be referred to their dentist for a more complete examination Every attempt should be made by school health personnel to work with parents, encouraging follow-up care with the dentist and getting feedback on any Table 21.1: Age-related oral health programs and activities used in Denmark school children Age (Years) Oral health topics Materials and visual aids 0–3 Information to parents about oral health, teething, tooth brushing, breastfeeding, dummies/bottles, nutrition, caries, medicine, dental trauma Picture books, posters, slides, video, models, food 3–5 Teach keeping the mouth clean, brushing the teeth and rinsing the mouth Leaflets, models, drawing and coloring sheets, puppet show, role-playing, songs 6-year-old teeth, oral hygiene, nutrition/food pyramid, shape and function of different teeth Picture books, slides, video, puppet shows, models, fishing games, food, jigsaw puzzles, drawing/exercise sheets 7–9 Importance of good dental health to physical health Dentitions: Function and structure of teeth, caries process Body/oral consciousness, hygiene, trauma Slides, videos, fishing games, food, leaflets on nutrition, models 10–12 Body, nutrition, hidden sugar and types of sweet, caries process, dental plaque, bacteria, caries registration, self-examination, importance of preventive measures Slides, videos, overhead projections, picture books, role-playing, cultivation of bacteria, worksheets, recipes, models 13–15 Health and well-being and oral health in general, structure of the tooth and its supporting tissues, initial caries and oral hygiene, approximal caries, healthy lifestyles, tobacco and nutrition, sweet drinks, hidden sugar Overhead projections, slides, videos, leaflets, X-rays, newspaper articles, worksheets, music, dental floss, nutrition, computer programs, statistics 16–17 Gingivitis/periodontitis, change to adult dental health care Oral cancer and preventive measures Slides, videos, leaflets, newspaper articles, qualityof-life game, computer program Modified from Stella YL.Kwan et.al Health-promoting schools; an opportunity for oral health promotion: Bulletin of the WHO (2005) 532 A Textbook of Public Health Dentistry Carrier—It is defined as an infected person or animal that harbors a specific infectious agent in the absence of disease and serves as a potential source of infection for others Case—It is defined as a person in the population or study group identified as having the particular disease, health disorder or condition under investigation Case Detection—It is the presumptive identification of unrecognized disease which does not arise from a patient request, e.g neonatal screening Case Fatality Rate—It is defined as the ratio of number of deaths due to a disease to the total number of cases due to the same disease Census—It is the total process of collecting, compiling and publishing demographic, economic and social data pertaining at a specified time or times to all persons in a country or delimited territory Certification—It is the process by which a nongovernmental agency or association grants recognition to an individual who has met certain predetermined qualification specified by that agency or association Child Mortality Rate—It is defined as “the number of deaths at ages to years in a given year per 1000 children in that age group at the midpoint of the year concerned” Cohort—It is defined as a group of people who share a common characteristic or experience within a defined time period (e.g age, occupation, exposure to a drug or vaccine, pregnancy, insured persons, etc) Cold Chain—It is a system of storage and transport of vaccines at low temperature from the manufacturer to the actual vaccination site Community (Osborn & Niemeyer)—A group of people living in a contiguous geographic area, having centers of interest and functioning together in the chief concerns of life It is a social group of individuals living in a given area and having a degree of “we” feeling Community Dental Health—It is that branch of dentistry which is practised in relation to population and groups, which derives from epidemiology an awareness of services required and which include the developmental of technique necessary to organize the application of these services for the benefit of the people Community Dentistry—It is that branch of dentistry which is practiced in relation to population and group, which derives from epidemiology an awareness of service required to organize the application of these services for the benefit of the population Community Health—Defined as including all the personal health and environmental services in any human community, irrespective of whether such services were public or private ones Community Medicine—It is that speciality which deals with populations and comprises those doctors who try to measure the needs of the people both sick and well, who plan and administer services to meet those needs and those who are engaged in research and teaching in the field Community Diagnosis—Generally refers to the identification and quantification of health problems in a community in terms of mortality and morbidity rates and ratios and the identification of these correlates for the purpose of defining those individuals or groups at risk or those in need of health care Community Organization—It is the process by which community groups identify common problems or goals, mobilize resources and in other ways develop and implement strategies for reaching the goals they have set [Minkler 1990] Communicable Disease—An illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, animal to animal or from the environment (through air, dust, soil, water, food etc), to man or animal Communicable Period—It is defined as the time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from and infected animal to man or from an infected person to an animal including arthropods Comprehensive Dental Care—Defined as “a process of providing preventive, therapeutic and maintenance care necessary for function, aesthetics and integrity of oral tissues with balanced consideration to patient’s physical, social, economic and psychosomatic status” Concept of Disease (Webster)—A condition in which body health is impaired, a departure from a state of health and alteration of human body interrupting the performance of vital functions Confounding Factor—It is defined as one which is associated both with exposure and disease and is distributed unequally is study and control groups Consent—When two or more persons agree upon the same thing in the same sense they are said to consent – section 13 of the Indian Contract Act, 1872 Contamination—It is defined as the presence of an infectious agent on a body surface also on or in clothes , surgical instruments, or substance including water, milk and food Contagious—A disease that is transmitted through contact Contract—Contract is defined as an agreement between two or more persons which creates an obligation to or not to a particular thing Cross-sectional Study—It is based on a single examination of a cross-section of population at one point in time, the result of which can be projected on the whole population Crude Death Rate—It is defined as “the number of deaths per 1000 population per year in a given community” Cultural Anthropology—Cultural anthropology is the branch dealing with man’s behavior and products Culture—It may be defined as a shared and organized body of customs, skill and ideas and values which is transmitted socially from one generation to another Defluoridation—Defluoridation is defined as a downward adjustment of fluoride ion concentration in a public drinking water supply so that the level of fluoride is maintained at the normal physiological limit of ppm to prevent dental caries with minimum possibility of causing dental fluorosis Dental Ancillary—It is a person who is given responsibility by a dentist so that, he or she can help the dentist render dental care but who is not himself or herself qualified with a dental degree Dental Calculus—Dental calculus is a hard deposit that forms by mineralization of dental plaque and is usually covered by a layer of unmineralized plaque Dental Caries—It is defined as a progressive, irreversible microbial disease of multifactorial nature affecting the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic portion of the tooth Dental Ethics—It is the moral obligation (duties) of the dentist towards the patient, his professional colleagues and to society at large Dental Fluorosis—It is a hypoplasia or hypomineralization of tooth enamel or dentine produced by the chronic ingestion of excessive amounts of fluoride during the period when teeth are developing Dental Plaque—Dental plaque is a complex, metabolically interconnected, highly organized, bacterial ecosystem It is a structure of vital significance as a contributing factor to the initiation of the carious lesion Dental Plaque—Dental plaque is defined as a highly specific variable structural entity formed by sequential colonization of microorganisms Definitions on the tooth surface, epithelium and restorations The natural physiologic forces that clean the oral cavity are inefficient in removing dental plaque Dental Plaque—Dental plaque is defined as a structured, resilient, yellow-grayish substance that adheres tenaciously to the intraoral hard surfaces, including removable and fixed restorations Dental Practice Management—It is defined as the process of obtaining and allocating inputs (human and economic resources by planning, organizing, staffing and directing and controlling for the purpose of outputs (dental services) desired by patients, so that practice objectives are achieved Dental Public Health (American Board of Dental Public Health)—It is the science and art of preventing and controlling dental disease and promoting dental health through organized community efforts It is that branch of dentistry or that form of dental practice which serve the community as a patient rather than the individual It is concerned with the dental health education of the public, with research and application of the findings of research, with the administration of programmes of dental care for groups and with the prevention and control of dental disease through a community approach Dental Health (WHO 1970)—It is the state of complete normality and functional efficiency of the teeth and the supporting structures and also surrounding parts of the oral cavity of the various structures related to mastication and maxillofacial complex Dental Health Education—It has been defined as the provision of health information to people in such a way that they apply it to everyday living In order to standardize a comprehensive definition of health education including dental health education, several national health organizations drafted the following definition “A process with intellectual, psychological and social dimensions relating to activity which increases the abilities of people to make informed decisions affecting their personal, family and community well being The process based on scientific principles, facilities learning and behavioural change in both health and consumers including children and youth” Dentifrice—It is a mixture used to clean the tooth surface in conjunction with toothbrush Dentist—A dentist is a person licensed to practice dentistry under the laws of the appropriate state, province, territory or nation To become licensed a prospective dentist must satisfy certain requirements such as, completion of a specified period of professional education in an approved institution, demonstration of competence, evidence of satisfactory personal qualities Dental Hygienist—It is an operating auxiliary licensed and registered to practice dental hygiene under the laws of the appropriate state, province, territory or nation Dental Laboratory Technician—it is a non-operating auxiliary who fulfils the prescriptions provided by dentist regarding the extra oral construction and repair or oral appliances Dental Assistant—It is a non-operating auxiliary who assists the dentist or dental hygienist in treating patients but who is not legally permitted to treat independently Denturist—it is a term applied to those dental laboratory technicians who are permitted in some states in the Unites States, some provinces of Canada, and in some other countries to fabricate dentures directly for patients without a dentists prescription Dependence—It is defined as the need for assistance in bathing, dressing, eating or transmitting from bed to chair 533 Diet—It is defined as the oral intake of substances that provide nutrition and energy Disability—Disability is any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being Disability (WHO 1982)—It is any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being Disaster—Any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area Disclosing Agent—A dye used in dentistry as a diagnostic aid, applied to the teeth to reveal the presence of dental plaque Disease—Definition by Webster: A Condition in which body’s health is impaired, a departure from a state of health and alteration of the human body interrupting the performance of vital functions Simplest Definition: It is just the Opposite of Health Disease Agent—It is defined as a substance living, or nonliving or a force, tangible or intangible the excessive presence or relative lack of which may initiate or perpetuate a disease process Disease Control—The term disease control described (ongoing) operations aimed at reducing • The incidence of disease • The duration of disease and consequently the risk of transmission • The effects of infection including both the physical and psychological complications and • The financial burden to the community Disinfection—It is defined as the killing of infectious agents outside the body by direct exposure to chemical or physical agents Double Blind Study—The study which is so planned that neither the doctor nor the participant is aware of the group allocation and the treatment received Early Diagnosis—The detection of disturbances of homeostatic and compensatory mechanism while biochemical morphological and functional changes are still reversible Ecology—It is the science of mutual relationship between living organisms and their environment Ecology of Health—It is the study of the relationship between variations in man’s environment and his state of health Effectiveness Evaluation—Effectiveness evaluation refers to whether program results meet predetermined objectives Effectiveness—Effectiveness is defined as the ratio between the achievement of the program activity and the desired level which, during the planning process, the planners had proposed would result from the program – WHO 1974 Efficiency Evaluation—Efficiency evaluation relates the results obtained from a specific program to the resources expended to maintain the program Efficiency—Efficiency is defined as the result that might be achieved through expenditure of a specific amount of resources and the result that might be achieved through a minimum of expenditure – WHO 1974 Endemic—It refers to the constant presence of a disease or infectious agent, within a given geographic area or without importation from outside, may also refer to the usual or expected frequency of the disease within such area or population group Environment—It can be defined as the sum total of all conditions and influences that effect the development and life of an organism 534 A Textbook of Public Health Dentistry Environmental Sanitation (WHO)—Controls for all those factors in man’s physical environment which exercise or may exercise a deleterious effect on his physical development, health and survival Enzootic—An endemic occurring in animals Epidemic—The unusual occurrence in a community or region of disease, specific health-related behavior or other health related events clearly in excess of expected occurrence Epidemiologist—An epidemiologist is any person who researches into the occurrence of disease or disability in groups of people Epidemiology—Epidemiology is defined as the study of the distribution and determinants of health related states or events in specified populations, and the application of this study to the control of health problems (John M Last 1988) Maxcy-Rosenau: Epidemiology is that field of medical science which is concerned with the relationship of various factors and conditions which determine the frequencies and distributions of an infectious process, a disease or a physiological state in a human community Paul JR: Defines epidemiology as that which is concerned with the circumstance under which disease occur, where disease tend to flourish and where they not Such circumstance may be microbiological or toxicological They may be based on genetic, social or environmental factors, even religious or political factors may come under scrutiny provided they are found to have come bearing upon disease prevalence WH Frost: Defines epidemiology as “the science which considers the occurrence, distribution and types of diseases of mankind, in distinct epochs of time at varying points on the earth’s surface and secondly, will render characteristics of the individual, and to the external conditions surrounding him and determining his manner of life American Epidemiological Society: Defined epidemiology “as the science which concerns itself with the natural history of disease as it is expressed in groups of persons related by some common factors of age, sex, race, location or occupation as distinct from development of disease in individuals Epizootic—An outbreak of disease in an animal population (often with the implication that it may also affect human populations) Epornithic—An outbreak (epidemic) of disease in a bird population Eradication—It is the termination of all transmission of infection by extermination of the infectious agent through surveillance and containment Erythroplakia—Erythroplakia is defined as a red lesion of the oral mucosa that cannot be characterized as any other definable lesion Ethics—It is defined as the science of morals, of moral principals of right and wrong, specifying rules of right behavior Ethics broadly are the unwritten laws of the profession embodying an expected standard of behavior It is the science of moral duty Evaluation—It is a process of making judgements about selected objectives and events by comparing them with specified value standards for the purpose of deciding alternative course of action Evaluation of Family Planning—Process of making judgments about selected objectives and events by comparing them with specified value standards for the purpose of deciding alternative course of action Exotic—Diseases which are imported into a country in which they not otherwise occur Expectation of Life—It is the average number of years that will be lived by those born alive into a population if the current age-specific mortality rates persist Express Contract—Express contract is an actual agreement of the parties, the terms of which are openly uttered or declared at the time of making it, being stated in distinct and explicit language, either orally (oral agreement) or in writing (written agreement) Expressed Need—Expressed need (Demands for Health care) arises out of attempts by members of the public to seek attention for their perceived needs External Environment of Men—It is defined as “all that which is external to the individual human –host Family—It is a group of individuals who are biologically related and living together and eating in a common kitchen It is a primary unit of society Family Planning—A way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and the social development of a country” Felt Need—Felt need (Perceived need) is the requirement of or care as determined by the patient or the public Fissures—Fissures are long clefts between cusps or ridges Folkways—Folkways are the patterns of conventional behavior in a society, norms that apply to everyday matters Food Additives—Non-nutritious substances, which are added intentionally to food, generally in small quantity, to improve its appearance, flavor, texture or storage properties Food Fortification—It is a process whereby the nutrients are added to foods in relatively small quantities to maintain or improve the quality of the diet of a group, a community or a population Foodborne Disease—A disease usually either infectious or toxic in nature caused by agents that enter the body through the ingestion of food Formative Evaluation—Formative evaluation is an examination of the activities of a program, as they are taking place Foetal Death—Death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy Four-handed Dentistry—Four-handed dentistry is the art of seating both the dentist and the dental assistant in such a way that both are within easy reach of the patient’s mouth F-ratio—A ratio of the variance between the group means over the variance within the groups; determines if the observed difference among the sample means is significant, statistics that result from ANOVA Functional Relationship—It is a relationship probably based on a complex system of interactions rather than being directly causal Geriatric Dentistry—American Association of Dental School (AADS) defines it that branch of dentistry that deals with the special knowledge, attitudes and technical skills required in the provision of oral health care to older adults The term older adults has no specific chronological boundary Gerodontology—It is defined as the multi disciplinary study of the process of ageing in the oro-facial area and its relations to the surroundings Gingivitis—Gingivitis is a disease characterized by inflammation restricted to the gingival soft tissues, with no loss of alveolar bone or apical migration of the periodontal ligament along the root surface Goal—It is the ultimate desired state towards which objectives and resources are directed Unlike objectives and targets, goals are not constrained by time or resource, nor are they necessarily attainable Group—Group is defined as a gathering of two or more people who have a common interest Group Practice—Group practice is defined as that type of dental practice in which dentists, sometimes in association with the members Definitions of other health professions agree formally between themselves on certain central arrangements designed to provide efficient dental health service ADA (1969) Guinea Pig Effect—It is thought to occur when subjects respond to data collection instruments itself; causing them to assume uncharacteristic behavior Rather it refers to adults who are affected by physical, social, psychological, physiological and biological changes associated with ageing with or without concomitant disease Habit—It is an acquired tendency to respond in an identical way to a situation or stimulus Handicap—A disadvantage for a given individual resulting from an impairment or a disability that limits or prevents the fulfillment of a role that is normal for that individual Handicapped Person—It is an individual child or adult who has been prevented by reason of his handicap from full participation in his normal activities for age Hazard—Any phenomenon that has the potential to cause disruption or damage to people and their environment Health—Definition by World Health Organization (WHO): A State of complete Physical, Mental and Social well-being and not merely the absence of disease or infirmity Oldest definition of Health: Absence of Disease Definition by Webster: The condition of being sound in Body, Mind and Spirit, especially freedom from Physical Disease and Pain Health Education—WHO 1969: To persuade people, to adopt and sustain healthy life practices; to use judiciously and wisely health services available to them and to take their own decisions both individually and collectively to improve their status and environment By National Conference on Preventive Medicine- USA- Is defined as the process which informs, motivates and helps people to adopt and maintain healthy practices and lifestyles, advocates environmental changes as needed to facilitate the goal and conducts professional training and research to the same end Health Appraisal—Has been defined as the process of determining the total status of the child through such means as histories, teachers and nurse observators, screening tests and medical, dental and psychological examinations Health Behavior—Any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behavior is objectively effective towards that end – WHO Health Promotion Glossary, 1986 Health Care Waste—Health care waste is defined as all the waste generated by health care establishments, research facilities and laboratories Health Communication—Health communication is defined as a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda The use of the mass and multimedia and other technological innovations to disseminate useful health information to the public, increases awareness of specific aspects of individual and collective health as well as importance of health in development – WHO Health Promotion Glossary, 1998 Health Information System (WHO 1973)—It is defined as a mechanism for the collection, processing, analysis and transmission of information required for organizing and operating health services and also for research and training Health Literacy—Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain 535 access to, understand and use information in ways which promote and maintain good health – WHO Health Promotion Glossary, 1998 Health Maintenance Organization—A Health Maintenance Organization (HMO) is defined as a legal entity which provides a prescribed range of health services to each individual who has enrolled in the organization, in return for a prepaid, fixed and uniform payments Health Manpower Planning—The process of estimation of the number of persons and the kind of knowledge, skills and attitudes they need to achieve predetermined health targets and ultimately health status objectives Health Needs (WHO 1971)—Are defined as deficiencies in health that call for preventive curatives, control and eradication measures Health for all—Defined as “the organized application of local, state, national and international resources to achieve health for all, i.e attainment by all people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life” Health Development (WHO)—It is defined as the process of continuous progressive improvement of the health status of a population Health Care (Last)—It is defined as a multitude of services rendered to individuals, families or communities by the agents of the health services or professions, for the purposes of promoting, maintaining, monitoring or restoring health Health Indicators—They are defined as variables which helps to measure changes Health Team (WHO)—It is defined as a group of persons who share a common health goal and common objectives, determined by community needs and towards the achievement of which each member of the team contributes in accordance with his competence and skills and respecting the functions of the other Health Services Research (WHO)—It is defined as the systematic study of the means by which biomedical and other relevant knowledge is brought to bear on the health of individuals and communities under a given set of conditions Health Promotion (WHO)—It is a process of enabling individuals to improve their health through personal choice and social responsibility Health Planning—The orderly process of defining community health problems, identifying unmet needs and surveying the resources to meet them, establishing priority goals that are realistic and feasible and projecting administrative action to accomplish the purpose of proposed program Health Promoting School—A health promoting school can be characterized as a school constantly strengthening its capacity as a health setting for living, learning and working – WHO TRS 870 Health Protection—The provision of conditions for normal mental and physical functioning of the human being individually and in the group It includes the promotion of health, prevention of sickness and curative and restorative medicine in all its aspects Holoendemic—A high level of infection beginning early in life and affecting most of the child population, leading to a state of equilibrium such that the adult population shows evidence of the disease much less commonly than the children Host—A person or other animal including birds and arthropods, that affords subsistence or lodgment to an infectious agent under natural conditions Hospital (WHO–1963)—A hospital is a residential establishment which provides short–term and long–term medical care consisting of 536 A Textbook of Public Health Dentistry observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturients, it may or may not also provide services for ambulatory patients on an out patient basis Housing—All places in which a group of people reside and pursue their life goals; the size of the settlement may vary from a single family to millions of people Hygiene—It is defined as the science of health and embraces all factors which contribute to healthful living Hyperendemic—It expresses that the disease is constantly present at a high incidence and/or low prevalence rate, and affects all age groups equally Hypothesis—It is a supposition arrived at from observing or reflection Iatrogenic—Any untoward or adverse consequence of a preventive, diagnostic or therapeutic procedure that causes impairment, handicap, disability or death resulting from a physician’s professional activity or from other professionals Immunity—It is possessing specific protective antibodies or cellular immunity as a result of previous infection or immunization Incidence—Incidence rate is defined as the number of new cases occurring in a defined population during a specified period of time Incremental Dental Care—It is defined as a periodical dental care so spaced that increments of dental diseases are treated at the earliest time, consistent with a proper diagnosis and operating efficiency in such a way that there is no accumulation of dental needs Incubation Period—The time interval between invasion by an infectious agent and appearance of first sign or symptom of the disease in question Infection—The entry and development or multiplication of an infectious agent in the body of a man or animal Infectious Disease—A clinically manifest disease of man or animals resulting from an infection Internal Environment of Man—It pertains to each and every component part, every tissue, organ and organ system and their harmonious functioning within the system Infant Mortality Rate—The ratio of infant deaths registered in a given year to the total number of live births registered in the same year; usually expressed as a rate per 1000 live births Impairment—Any loss or abnormality of psychological or anatomical structure or function Incineration—A high temperature dry oxidation process that reduces organic and combustible waste to inorganic incombustible matter and results in a very significant reduction of waste-volume and weight Incremental Dental Care—Defined as the treatment of the children at the earliest at which they are available and providing maintenance care through periodic treatments The treatment is provided by taking the youngest available group in the first year and then carrying it forward in subsequent years as far as the funds permit, each year adding a new class of children at the next earliest age, until an entire child population is being served to as high an age as available resources permit Index (Russell)—An index has been defined as a numerical value describing the relative status of a population on a graduated scale with definite upper and lower limits, which is designed to permit and facilitate comparison with other populations classified by the same criteria and methods Infection—The entry and development or multiplication of an infectious agent in the body of man or animals Infectivity—It is defined as the ability of an infectious agent to invade and multiply on a host Intervention—Can be defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man Interceptive Orthodontics—It is the phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dento–facial complex Isolation—Separation for the period of communicability of infected persons or animals from others in such places and under such conditions as to prevent or limit the direct or indirect transmission of the infectious agent from those infected to those who are susceptible, or who may spread the agent to others Jurisprudence—It is the philosophy of law, or the science that treats the principles of law and legal relations Latent Period—It is the period from disease initiation to disease detection Level of Living—As per United Nations documents level of living consists of nine components: health, food consumption, education, occupation and working conditions, housing, social security, clothing, recreation and leisure, and human rights Licensure—It is the process by which an agency of government grants permission to those meeting predetermined qualifications to engage in a given occupation and use a particular title or by which it grants permission to perform specified function Longitudinal Study—It is defined as study in which the same individuals are examined on repeated occasions and changes within a group are recorded in lapse of time Macro-environment—Is defined as all that which is external to the individual human host, living and non living and with which he is in constant interaction Malnutrition—It is a pathological state resulting from a relative or absolute deficiency of excess of one or more essential nutrients Manpower—It is defined as individuals with a kind of knowledge, skills and attitude needed to achieve predetermined health targets and ultimately health status objectives Matching—It is defined as the process by which we select the controls in such a way that they are similar to cases with regard to pertinent selected variables which are known to influence the outcome of disease and which if not adequately matched for comparability could distort or confound the results Materia Alba—It is a deposit composed of aggregate of micro organisms, leukocytes and dead exfoliated epithelial cells randomly organized and loosely adhered to surfaces of teeth, plaque and gingiva Maternal Death—Deaths associated with complication of pregnancy, child birth and puerperium Mental Dimension—A state of balance between the individual and surrounding world, in a state of harmony between oneself and other; coexistence between reality of the self and that of other people and that of environment Modes of Intervention—It is defined as any attempt to intervene or interrupt the usual sequence in the development of disease in man Monitoring—The performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population” Morbidity—It is defined as any departure subjective or objective from a state of physiological well being Mortality Rate—The number of deaths due to a disease in a general population in a community (that is not just among cases) Motives—Emotional emerging forces which bring certain features of belief to the forefront of consciousness, make personal and immediate changes and push the person towards acting upon them Definitions National Health Policy—It is an expression of goals for improving the health situation, the priorities among these goals and the main directions for attaining them National Pathfinder Survey—It is a collection of data incorporating sufficient examination sites to cover all important subgroups of the population that may have differing disease level or treatment needs, and at least three of the age groups are index ages, for the planning and monitoring of the services Neonatal Mortality Rate—It is the number of neonatal deaths in a given year per 1000 live births in that year Nosocomial Infection—Nosocomial infection (hospital acquired) is an infection originating in a patient while in a hospital or other health care facility Nutrition—The science of food and its relationship to health It is concerned primarily with the part played by the nutrients in body growth development and maintainance Odds Ratio (OR)—It is a measure of the strength of association between the risk factor and outcome Opportunistic Infection—This is infection by an organism that takes the opportunity provided by the host defense to infect the host and hence cause the disease Oral Health Survey (WHO)—It is defined as survey to collect the basic information about oral disease status and treatment needs that is needed for planning or monitoring oral health care programs Outbreak—The sudden, unexpected pronounced increase in the occurrence of disease usually focally in the limited section of the patient Pandemic—An epidemic usually affecting large proportion of the population occurring over a wide geographic area such as a section of nation, the entire nation, continent or the world Physician (WHO)—A physician is a “person who, having been regularly admitted to a medical school, duly recognized in the country in which it is located, has successfully completed in the prescribed courses of studies in medicine and has acquired the requisite qualification to be legally licensed to practice medicine (comprising prevention, diagnosis, treatment and rehabilitation) using independent judgment to promote community and individual health” Physical Environent—It is applied to non living things and physical factors (eg air, water, soil, housing, climate etc) with which man is in constant interaction Plan (Planning)—(By EC Banfield) It is a Decision about a course of action It is a systemic approach to defining the problem, setting priorities developing specific goals and objectives and determining alternative methods and strategies for implementation Pollution—It is distinct from contamination and implies the presence of offensive but not necessarily infectious matter in the environment Preventive Medicine—It is defined as meaning not only the organized activities of the community to prevent occurrence as well as progression of disease and disability, mental and physical, but also the timely application of all means to promote the health of individuals and of the community as a whole, including prophylaxis, health education and similar work done by a good doctor in looking after individuals and families Preventive Dentistry—Procedure employed in practice of dentistry and community dental health programmes which prevent occurrence of oral disease and oral abnormalities Primary or Definitive Hosts—They are hosts in which the parasite attains maturity or passes its sexual stage Primary Prevention—Action taken prior to the onset of disease which removes the possibility that a disease will ever occur 537 Prevalence—Refers specifically to all current cases(old and new) existing at a given point in time, or over a period of time in a given population Point Prevalence—It is defined as the number of all current cases (old and new) of a disease at one point in time in relation to a defined population Period Prevalence—It is defined as the frequency of all current cases(old and new) existing during a defined period of time, expressed in relation to a population Profession—Defined as “a calling requiring specialized knowledge and often long and intensive academic preparation” and “the whole body of persons engaged in a calling” Professionalism—It is the conduct, aims or qualities that characterize or mark a profession or professional person Positive Health (WHO)—Implies that a person should be able to express as completely as possible the potentialities of his genetic heritage Prosodemic—Pertaining to infections that maintain themselves in human populations by a variety of mechanisms of transmission Plaque—Plaque is a specific but highly variable structural entity resulting from colonization of microorganisms on tooth surfaces, restorations and other parts of oral cavity which consists of salivary components like mucin, desquamated epithelial cells, debris and microorganisms all embedded in a gelatinous extra cellular matrix Plaque Control—Plaque control is the removal of microbial plaque and the prevention of its accumulation on the teeth and adjacent gingival tissues Besides, its also deals with the prevention of calculus formation Pit and Fissure Sealant—Defined as a cement or resin material which is introduced into unprepared occlusal pits and fissures of caries susceptible teeth forming a mechanical and physical protective layer against the action of acid producing bacteria and their substrates Postneonatal Mortality Rate—The ratio of post neonatal deaths in a given year to the total number of live births in the same year; usually expressed as a rate per 1000 Precancerous Lesion—Precancerous lesion is defined as morphologically altered tissue in which cancer is more likely to develop than in its apparently normal counterpart Precancerous Condition—Precancerous condition is a generalized state associated with a significantly increased risk of cancer Primordial Prevention—Primordial prevention is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared Prevalence—The total number of all individuals who have an attribute or disease at a particular time divided by the population at risk of having the attribute or disease at this point in time or midway through the period Psychological Environment—It includes a complex of psychological factors which are defined as “those factors affecting personal health, health care and community well being that stem from the psychological makeup of individuals and the structure and functions of social groups Public Health (Defined by Winslow in 1920)—Defined as the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventing treatment of disease, and the development of social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birth right of health and longevity 538 A Textbook of Public Health Dentistry Quality of Life (WHO)—As the condition of life resulting from the combination of the effects of the complete range of factors such as those determining health, happiness (including comfort in the physical environment and a satisfying occupation) education, social and intellectual attainments, freedom of action, justice and freedom of expression Quarantine—The limitation of freedom of movement of such well persons or domestic animals exposed to communicable disease for a period of time not longer than the longest usual incubation period of disease, in such manner as to prevent effective contact with that not so exposed Range—It is the simple measure of dispersion, the difference between smallest and largest values in data Random Sampling—It is a sampling procedure in which every element in the population has an equal and independent chance of being selected Recommended Daily Intake—The amounts of nutrients sufficient for the maintenance of health in nearly all people Registration—It is defined as an attribute or exposure that is significantly associated with the development of a disease Rehabilitation (WHO)—It is defined as the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability Relative Risk—It is the ratio of the incidence of disease among exposed and incidence among non exposed Reservoir—It is defined as any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an infectious agent lives and multiplies, on which it depends primarily for survival and where it reproduces itself in such manner that it can be transmitted to a susceptible host Risk Factor—It is defined as a determinant that can be modified by intervention thereby reducing the possibility of occurrence of disease or other specified outcomes Risk Ratio—It is defined as the ratio between the incidence of disease among exposed persons and incidence among non exposed Sample—It is the representative part of a whole group of people or population to be studied Screening—It is defined as the use of presumptive methods to identify unrecognized health risk factors or asymptomatic disease in persons determined by prior studies to be potentially at elevated risk and able to benefit from interventions performed before overt symptoms develop WHO, 1994 Secondary Attack Rate—It is defined as the number of exposed persons developing the disease within the range of the incubation period, following exposure to the primary case Secondary Prevention—It can be defined as action which halts the progress of a disease at its incipient stage and prevents complications Self Care in Health—It is defined as those health generating activities that are undertaken by the persons themselves Segregation—It is the separation for special consideration, control of observation of some part of group of persons from the others to facilitate control of communicable diseases Sentinal Surveillance—It is a method for identifying the missing cases and thereby supplementing the notified cases required Sewage—The waste water from a community, containing solid and liquid excreta, derived from houses, street and yard washings, factories and industries Social Dimension—Quantity and quality of an individual, interpersonal ties and the extent of involvement with the community Social Integration—It is defined as the active participation of disabled and handicapped people in the mainstream of community life Sociology—It is the science concerned with the organization or structure of social groups Society—A group of individuals who have organized themselves and follow a given way of life Society—Is a system of uses and procedures of authority and mutual aid of many groups coupled with divisions of control of human behaviour and liberty Source—The person, animal, object or substance from which an infectious agent passes or is disseminated to the host Spectrum of Disease:Spectrum of disease is defined as the sequence of events that occur in the human host from the time of contact with the etiologic agent up to the point of the ultimate outcome, which may be fatal in the extreme cases Sporadic—The word sporadic means scattered about The cases occur haphazardly from time to time and generally infrequently, the cases are so few and widely distributed in space and time that they show little or no connection with each other, nor a recognizable common source of infection Standard of Living—Refers to the usual scale of our expenditure, the goods we consume and the services we enjoy It includes the level of education, employment, status, food, dress, house, amusement and comforts of modern living Standard Deviation—It is the square root of the square deviation from the mean and dividing by the number of observation Statistics—It is the method of collecting, organizing, analyzing and interpreting of data Sterilization—It is a process by which an article, surface or medium is freed of all microorganisms either in vegetative or spore state Surveillance—The continuous scrutiny of the factors that determine the occurrence and distribution of the disease and other conditions of ill health Survey—The method of collection of data, analyzing and evaluating the data in order to determine the amount of disease problems in a community and also identify cases that have not been identified Survey—Survey is an non experimental type of research that attempts to gather information about the status quo for a large number of cases by describing present conditions without directly analyzing their causes Taboo—Taboo is a strong social prohibition (or ban) aganist words, objects,action or discussions that are considered undesirable or offensive by a group, culture, society, or community Tertiary Prevention—All measures available to reduce or limit impairments and disabilities, minimize suffering caused by existing departures from good health and to promote the patients adjustments to irremediable conditions Tooth Mortality—Number of lost teeth divided by total number of teeth possible in the group Tooth Fatality—Number of missing teeth divided by decay missing filled teeth Transport Host—It is defined as a carrier in which the organism remains alive but does not undergo development Utilization of Services—The proportion of people in need of a service who actually receive it in a given period, usually a year Vaccine—Vaccine is an immunobiological substance designed to produce specific protection against a given disease Vector—The term vector is commonly used to describe arthropods which transmit infectious agents from human to human or from animal to human Definitions Vehicle—A medium through which an infectious agent is conveyed to man, most commonly used with reference to drinking water or food Virulence—It is defined as the proportion of clinical cases resulting in severe clinical manifestations (including sequelae) Vital Statistics—It is defined as the facts related to vital events, systematically collected and numerically compiled Water Fluoridation—It is defined as an upward adjustment of fluoride ion concentration in a public drinking water supply so that the level of fluoride is maintained at the normal physiological level of ppm to prevent dental caries with minimum possibility of causing dental fluorosis 539 Water Defluoridation—It is defined as a downward adjustment of fluoride ion concentration in a public drinking water supply so that the level of fluoride is maintained at the normal physiologic limit of ppm to prevent dental caries with minimum possibility of causing dental fluorosis Water Fluoridation—Is defined as the upward adjustment of concentration of fluoride ion in a public water supply in such a way that the concentration of fluoride ion in the water may be consistently maintained at one part per million (ppm) by weight to prevent dental caries with minimum possibility of causing dental fluorosis Zoonosis—An infection or infectious disease transmissible under natural condition from vertebrate animals to man Index A B Abnormal frenal attachments 424 oral musculature 425 Abrasion 434 Acesulfame potassium 316 Acidulated phosphate fluoride 351 Ackerman-Profitt system of classification 148 Active gingivo-salivary route 380 Active immunization in humans 380 Acute fluoride toxicity 367 Additive method 371 Adsorption method 371 Advanced periodontitis 416 Air pollutants 43 Ajit foundation 52 Alban’s test 326 All India Women’s Conference 52 Ambience of dental clinic 489 Amine alcohols 302 Amorphous calcium phosphate 394 Angle’s classification of malocclusion 144 Antibiotics 299 Anticalculus 294 Anticaries 294 Anti-plaque agents 294 Application of computers in dentistry 511, 515 fluoride 351 sealant material 388 Approaches in plaque control 277 Appropriate levels of fluoride in drinking water 335 Aqueous solutions 349 Artificial fluoridation 334 water fluoridation 331 Ascorbic acid 82 Askov dental health education 248 Aspartame 316 Atraumatic restorative treatment 395 Auxiliaries personnel in India 216 Balanced diet 75 Bar graph 25 Barrier techniques 458 Basal energy requirement 75 Basic dental care and dental procedures 218 dietary recommendations 408 Stephan curve 310 Bass method 282 Behavior management in community dentistry 488 Behavior modification in geriatrics 412 high caries risk children 412 Bennette’s classification of malocclusion 147 Biomedical waste management 469 Bionic toothbrush 281 Biostatistical data analysis 515 Bisbiguanide antiseptics 301 Bite marks 503 sample 504 Biting lip/nail/pen/pencil 430 Black tea 315 Bleeding assessment 196 Blue cross/blue shield 221 Body of lesion 106 Bone score 197 Box and whiskers plot 25 Bristles 279 Brudevolds solution 351 Buccal mucosa 137 Buffer capacity test 328 Build healthy public policy 142 Bulk sweeteners 316 C CAD/CAM 512 Calcium 79, 124, 294 Calculations for common mortality rates 12 Calculus 123, 195, 276 score 190 surface index 193 Carbohydrates 75 and dental caries 313 nature 311 Carbon monoxide 129 Carcinoma of buccal mucosa 134 floor of mouth 134 gingiva 135 lip 133 palate 135 tongue 134 Care of mouthguard 444 Caries activity tests 324 balance 409 disease indicators 317 formation 401 of dentine 106 of enamel 105 process 102 related to restoration margin 400 susceptibility 318 vaccine 382, 403, 407 Cariogenicity of mutans streptococci 377 sugars 313 Cariogram 322 Caste system 478 Categories of orofacial injuries 446 rates 11 Catholic relief services 63 Cation exchange resins 371 Causes of periodontal disease 116 xerostomia 320 Certainly lethal dose 368 Cessation of fluoridation 344 542 A Textbook of Public Health Dentistry Characteristics of persons 13 place 14 screening test 21 time 14 traditional medical systems 481 Charter’s method 284 Cheiloscopy 507 Chemical plaque control 419 theory 104 vapor 463 Chemoparasitic theory 104 Chemotherapeutic method of plaque control 420 products 277 Chi square distribution 29 Child psychology 483 Chlorhexidine 301, 302 rinses 296 Classical conditioning theory 485 Classification of dental caries 104 malnutrition 83 malocclusion 144 periodontal disease 119 pits and fissures 384 space maintainers 427 Classroom tooth brushing 243 Cleaning prepared cavity 396 Clinical evaluation of dental trauma 447 Codes describing metastasis 136 tumor 136 Cohort studies 18 Commercial insurance plan 220 Common mucosal immune system 379 study designs in epidemiology 15 Community health centers 60 periodontal index 176, 201 service 266 water fluoridation 342, 404 Complete material loss 400 Components of infection control 457 primary health care 56 SPT 421 Comprehensive dental care 212, 529 school health education 241 Computer odontology 508 Computerized periodontal probe 514 Computers in dentistry 509 orthodontics 513 Concentration of sugar 309 Concept of health 224 primary health care 55 public health 88 Conduct of dentist towards public 269 Connective tissue disease 320 Constituents of forensic odontology 501 tobacco smoke 129 Consumer disputes redressal agencies 523 protection Act 522 Consuming fluoride-rich diet 405 Contents of health education 156 Continuing dental education program 233 Control fluorosis 374 Copolymer membrane device 355 Coupling with cholera toxin subunits 381 Custom-made mouthguard 444 Cyanoacrylate toxicity 453 Cyanocobalamin 82 D Dean’s fluorosis index 207 Debris score 190 Deficiency disorders 81 Definition of dental public health 89 health 87 promotion 224 medical anthropology 481 mouthguard 442 public health 87 Defluoridation of water 369, 371, 373 Delmopinol 302 Dental aesthetic index 210 caries 100, 104, 105, 229, 306, 410 index for deciduous teeth 205 pandemic 100 vaccines 381 chair 467 charting 305 Council of India 253, 267 education 516 floss 286, 418 fluorosis 176, 368 index 209 handpieces 519 health education 156, 245 inlays and crowns 480 irrigation devices 291 laboratory technician/certified dental technician 214 office 498 treatment for avulsed tooth 448 plaque 111, 122, 273, 276 public health 90, 92, 93 programs in Seychelles 250 qualifications 255 screenings 248 sealants 248 secretary/receptionist 214 surgery assistant 214 team 212 therapist 215 Dentifrices 292 Dentist Act of India and Indian dental association 258 Dentofacial anomalies 180 Denture brush 297 marking 503 Design of basic oral health survey 167 epidemiological studies 13 Determinants of health 3, 4, 227 periodontitis 119 Develop personal skills 142 Dewar’s test 327 Dewel’s method 433 Dextranases 378 Dietary carbohydrates 313 factor and dental caries 312 fiber 77 habits 320 supplements 345 Dimensions of health Dimethicones 295 Disadvantages of dental floss 286 parental presence 490 Disease prevention Dismissal of frivolous or vexatious complaints 525 Disorders of malnutrition 82 overnutrition 84 Disposal of contaminated wastes 465 Dissipation of forces 442 Distinguishing skeletal traits 508 DMFT scores 205 Domestic defluoridation 374 Drinking water 363 Dry heat 462 Dutch study 335 E Early childhood caries 111 gingivitis 118 treatment of large overjets 447 Economic burden of oral diseases 232 Economics of fluoridation 342 Eight-component model 240 Elements of health promotion 226 school oral health program 248 Index Enamel opacities/hypoplasia 175 slab experiments 309 Endogenous sources of corrosion 436 theories 103 Epidemiological factors in periodontal disease 124 Epidemiology of dental caries 98 periodontal disease 114 tooth wear 437 Ergonomics in dentistry 517 Essential public health services 88 Established gingivitis 118 Establishment of dental office 497 Etch surfaces 387 Ethics in dentistry 265 of water fluoridation 344 Ethnic group 174 inequalities in health 479 Evaluation of tooth mobility 203 Evidence in caries reduction 361 of trauma 508 Evolution of human society 473 Executive committee 264 Exercises of Masseter muscles 430 pterygoid muscles 431 tongue 430 Exfoliation of deciduous teeth 424 Exogenous sources of corrosion 436 theories 104 F Family Planning Association of India 51 Fat soluble vitamins 79 Feasibility of water fluoridation in india 337, 343 Fibrous foods 315 Filaments 279 Findings of district forum 524 on dental examination 507 Fissure sealants 387 Flocculation 373 Floss holder 288 threader 287 Fluoridated toothpaste 359 Fluoride 111, 248, 294, 302, 403, 404, 439 absorption 332 action 339 administration 341 application techniques 356 applied by dentist/ professionally applied 349 compound used in water fluoridation 336 concentration in toothpaste 358 containing devices 355 sealants 390 dentifrices 358 and topical fluoride mousse or gels 437 excretion 333 exposure from multiple sources 360 gels 351 in biosphere 332 in calcified tissues 333 in dentistry 330 in drinking water 366 in environment 331 in plasma 332 in water and atmosphere 331 intake 332, 364 intake from beverages 364 dentifrices 365 food products and infant formula 364 milk and formula 364 mouthrinses 365 professional and self-applied fluoride gels 366 water 364 mechanism of action 362 metabolism 332 mouthrinses 360 prophylactic paste 354 supplementation in form of tablets and lozenges 405 tablets, lozenges and drops 345 toxicity 366 treatment 305 varnishes 352 vitamin preparation 347 Fluoridized milk and fruit juices 347 Fluorosis index 207, 208 Folic acid 82 Fones method 285 Food and Agriculture Organization 63, 67 Ford foundation 73 Forensic anthropology 507 dentistry 501 radiology 506 Formation of dental plaque biofilms 273 microcolonies 274 Fosdick’s calcium dissolution test 327 Foundation strengths 69 Four-handed dentistry 216 Frankel behavior rating 488 Frequency of SPT 421 tooth cleaning 418 543 Frequency polygon 25 Freudian theory 483 Fruits and dental caries 315 Functions of public health dentistry 95 G Gastric reflux 440 Gauze strip 290 Genomic and mitochondrial DNA in forensic dentistry 503 Gingivae 117 Gingival bleeding index 195 bone count index 197 index 193 score 197, 203 Gingivitis 114, 118, 415 Glass device 355 Glucan binding protein 378 Glucosyltransferase 378 Goals of fluoride administration 341 oral health 228 prevention of dental caries 402 SPT 420 Graber’s classification 153 H Hand hygiene 457 instruments 519 Hardness of water 42 Health agencies of world 61 education and propaganda/publicity 159 maintenance organization 222 promoting schools 242 Healthy gums 415 Hearing loss 453 Heat transfer 463 Hind Kusht Nivaran Sangh 52 Humectant 293 Hydrogen cyanide 129 Hypervitaminosis 84 Hypnosis 492 I Ideal caries activity tests 324 dental caries vaccines 375 requisites of index 186 toothbrush 278 school dental program 244 sealant 384 Identification number 173 of dental caries 204 544 A Textbook of Public Health Dentistry Illuminating pit and fissure sealant 394 Impact of oral disease 88 Importance of diagnosis of dental caries 104 early detection 140 learning child psychology 483 Improves tooth morphology 341 Improving reproductive health 71 Incidence density 12 rate 12 Increased enamel resistance 339 rate of post-eruptive maturation 340 Incremental dental care 251 Independent practice association 222 Index of orthodontic treatment need 210 teeth 198 Indian Council for Child Welfare 50 Indian Dental Association 261 Indices for dental caries 204 malocclusion 210 Indoor air pollution 44 Industrial exposure 363 Inhibition of bacterial enzyme system 340 Inorganic constituents 39 Instrument design 519 sterilization and disinfection 461 Intense sweeteners 316 Interception of developing skeletal malocclusions 433 Interceptive orthodontics 427 Interdental oral hygiene aids 285 International Committee of Red Cross 69 red cross and red crescent movement 62 Interproximal brushes 289 Intranasal route 379 Intraoral barrier technique 460 camera 514 distribution 121 examination 448 factors 113 Introduction to epidemiology public health dentistry 87 Iodine 79 deficiency 84 Ion-exchange 371 Ionic toothbrushes 281 Iron 79, 124 deficiency 83 Isolate teeth 387 J Jakarta declaration 226 K Kasturba Gandhi Trust 51 Knutson’s technique 349 L Labial mucosa 137 Lactobacilli counts 325 Latex allergy 460 hypersensitivity 451 Leonard method 285 Levels of prevention of dental caries 411 periodontal disease 420 Limitations of dental radiography 507 DMFT index 205 intense sweeteners 316 muscle exercises 431 Line graph 25 Liposomes 381 Lips 137 List of national health programs of India 52 Longitudinal study 16 Loop method 287 Lower back pain 518 Millennium development goals 68 Minimize extreme joint position 518 Minor salivary gland 379 Mixed dentition 206 Mobility index 203 Models of health education 158 Moderate periodontitis 416 Modified bass technique 283 plaque scoring system of Turesky 202 Snyder’s test 326 Stillman’s technique 284 Molecular pathogenesis of dental caries 375 Monitoring art restorations 399 Monoclonal antibodies 380 Mouth breathing 430 formed mouthguard 443 Mouthrinses 295 Mouthwash 295 Muhler’s technique 350 Multilateral organizations 61 Muscle exercises 430 Musculoskeletal disorders and diseases of peripheral nervous system 453 Mutans streptococcal colonization 377 Mutilations of teeth and oral soft tissues 480 M N Mahler’s theory 487 Mainpuri tobacco 130 Major dental care 218 Malocclusion 152 Manual toothbrushes 278 Mass disaster 505 Mechanical plaque control 277, 419 Mechanism of action of fluorides 337 sodium fluoride 350 defluoridation 373 Medical anthropology 481 aspect of water fluoridation 343 Methods of age estimation in adults 506 disposal of waste 47 oral health promotion 227 preparation 360 prevention of dental caries 402 periodontal disease 417 qualitative evaluation 239 quantitative evaluation 239 using dental floss 286 varnish application 353 water fluoridation 336 Mild periodontitis 416 Milk fluoridation 405 Nalgonda technique 373, 374 Nance’s method 433 National AIDS control program 53 cancer control program 53 health programs 52 institute of dental research 235 iodine deficiency disorders control program 53 leprosy eradication program 53 mental health program 54 oral health program in India 230 program for control of blindness 53 training center 235 Navy periodontal disease index 202 plaque index 188 Newer sealants 391 Niacin or nicotinic acid 82 Nicotine 129 Nitrogen oxides 129 Nitrous oxide 453 Non-communicable diseases 157 Non-operating auxiliary 213 Non-pharmacologic behavior management 490 Nonprofit health service corporations 221 Non-skeletal manifestations 369 Non-sugar sweeteners and dental caries 315 Nutrition Foundation of India 51 Index O Opening condylar space 442 Operating auxiliaries 215 ORA test 327 Oral cancer 126 prevention 141 health assessment form 173 care system in India 54, 231 education 232, 244 problems in India 231 promotion 224-226 set-up 233 survey procedures 165 hygiene 111, 122 assessment 415 index 189 promotion 303 mucosa 175 prophylaxis 304 route 379 Organization of health system in India 49 Origin of primary health care 55 Ottawa charter for health promotion 225 P Palate 139 Pan masala 130 Papain 295 Papillary-marginal-attached gingival index 196 Partial material loss 400 Parts of toothbrush 278 Passive immunization 380 Pathfinder surveys 168 Patient hygiene performance index 192 Pearson Chi-square 29 Pellicle formation 274 Periodontal disease 117, 118, 415 index 194 progression 415 index 193 ligament 118 Periodontitis 119 Perioral and intraoral soft tissue examination 137 Permanent teeth 345, 448, 449 Pharmacokinetics of fluoride 333 Phenols and essential oils 300 Phosphate 294 Pie diagram 26 Pipe cleaner 290 Pit and fissure caries 106 sealants 384, 394 Plaque control record 188 index 187, 188 pH studies 309 toothpick method 328 Pocket score 203 Pollution of water 35 Post-eruptive systemic effects 338 topical effects 338 Postmortem dental profiling 502 Postnatal counseling 423 Postpayment plan 219 Post-survey assistance 181 Potassium salts 295 Potential injuries 445 Potentially malignant lesions 131 Poverty line 478 Powered toothbrushes 279 Prevalence of gingivitis 114 malocclusion 150 periodontitis 115 tooth wear and erosion in adolescents 438 adults 439 deciduous dentition 438 Preventing dental injury in child care 445 HIV/AIDS 71 Prevention of accidents 157 dental caries 401, 402 trauma 441, 445 disease ergonomic injuries 518 fluorosis 369 malocclusion 422 occupation hazards 454 oral cancer 140, 142 periodontal disease 415, 416 root caries 412 tooth wear 439 Preventive orthodontics 422 resin restorations 389 steps against litigation 525 treatment for erosion 437 Primary health care system in India 59 centers 60 prevention of dental caries in children 411 tooth 448 Professional fluoride application 356 Professionally applied fluorides 349 topical fluorides 361 545 Protein energy malnutrition 83 Proteolysis chelation theory 104 Proteolytic theory 104 Pseudo class III-malocclusion 146 Psychodynamic theories 483 Psychosocial theory 485 Public health expenditure 232 problem 88 sealant programs 390 supervision 214 Purification of water on large scale 35 small scale 38 Pyrophosphate 294 Q Quasi-experimental studies 15 Quaternary ammonium compounds 301 R Radiation exposure 454 Radiographic asepsis 465 Rate of diffusion 311 Reductase test 326 Reduction of rotational forces 442 Refugee and disaster relief organizations 63 Rehabilitation after oral cancer 141 Removal of plaque 403, 407 Reorient health services 142 Reorientation of dental education in India 235 Requirements for water fluoridation 342 Resolution of crowding 431 Restorative materials containing fluoride 354 Restoring cavity 396, 398 Retained deciduous tooth/teeth 431 Riboflavin 82 Rockefeller foundation 72 Role of dental colleges 234 diet 306 DNA technology 503 public health 87 dentists 530 saliva 307 teeth in determination of human identity 502 Rolling stroke 284 Root caries 108, 111, 113 surface caries 344 Rubber tip stimulator 296 Rules for scoring DMFT 204 Rural health care system in India 59 S Saccharine 316 546 A Textbook of Public Health Dentistry Safely tolerated dose 368 of fluoride dentifrices 359 Saliva 110, 320, 333, 440, 505 flow rate 311 substitutes containing fluoride 403, 406 tongue blade method 328 Salt fluoridation 346, 347, 404 Saturator system 336 Scaling and root planning 419 School based dental health program 243 oral health education program in China 250 dental health programs 240, 246 nurse 215 services 242 environment 489 fluoride mouth rinsing program 243 tablet program 243 oral health program in India 251 Kuwait 251 water fluoridation 244, 345 Scope of epidemiology Scoring criteria for calculus 195 plaque 195 russels index 194 Scoring PDI 195 Scrub brush method 285 Sealant program 243 Selection of mouthguard 442 place 497 teeth 195, 204, 208 and surfaces 188, 194, 196 Self applied fluorides 243, 358 Sensing gingival pockets 198 and calculus 201 Septic theory 104 Seven fundamental principles of red cross 69 Sibling rivalry 489 Significant caries index 207 Simplified oral hygiene index 190 Single tuft brushes 289 Skeletal classification 148 fluorosis 369 Smiling schools project in Namibia 250 Smith’s method 285 Smokeless tobacco 130 Smooth surface caries 105 Snyder’s test 325 Social learning theory 487 Sodium bicarbonate 294, 295 fluoride 349 Lauryl sulfate 294 Sonic and ultrasonic toothbrushes 281 Sources of fluorides 172, 363 radiation exposure 45 water supply 34 Special treatment of water 43 Specific nutritional deficiency states 83 vaccine targets 378 Spool method 286 Stacked bar 26 Stannous fluoride 302 Stem and leaf plot 24 Stephan curve 312 Steps in mouthguard formation 444 oral prophylaxis 304 randomized control study 18 Stillman’s method 283 Stock mouthguard 443 Streptococcus mutans adherence method 329 screening test 328 Structure of periodontal tissues 117 Subgingival cleaning 304 plaque 276 Sugar-laden western diets 98 Sulcal lavage 305 Sulcular brushing 282 Super floss 287 Supernumerary teeth 431 Supportive periodontal therapy 420 Supra and subgingival calculus 123 plaque 276 Supragingival cleaning 304 plaque 276 Swab test 328 Systemic fluorides 342 use of fluoride 403 Thiamine 81 Thylstrup-Fejerskov index 208 Tiel-Culemborgh study 335 TNM system 135 Tobacco carcinogenesis 132 lime preparation 130 Tongue scrapers 292 thrusting 429 Tonsillar route 379 Tools of dental public health 93 Tooth avulsion 480 loss 229 malalignment 121 mutilations 480 numbers in FDI system 192 surface index of fluorosis 208 wear 434 Toothbrushing 278, 418 techniques 282 Toothpaste formulations 358 Toothpick 288 holder 289 Topical fluoride 348, 357, 405 application program 244 Training of trainer 235 Tray technique 356 Triclosan 294 T-test 30 Turesky modification 202 Tweed’s method 432 Types of cohort studies 17 dental floss 286 descriptive studies 14 evaluation 238 mouthguard 443 MSDS 518 power toothbrushes 280 radiation 45 screening 20 sealants 384 sugar 309 supervision 213 surfacing 446 T U Tattle tooth package 247 Teachers training program 251 Temporomandibular joint assessment 174 Theories of child psychology 483 dental caries 103 disease causation 4, Theta program 247 UCR fee method 220 United Nations Development Program 68 Population Fund 70 Urine 333 Uses of basic oral health surveys 168 dental floss 286 Index epidemiology euphemisms 490 fluorides 320 health services 157 intense sweeteners 316 planning 236 screening 20 water 34 Utilization of mass media 232 V Vaccination 375 Vaccines 376 Various caries activity tests 325 Viral infection 132 theory 103 Vitamin A 79 B complex 81 B1 81 B11 82 B12 82 B2 82 547 B4 82 C 82, 124 D 81 E 81 K 81 Voluntary health agencies in India 50 association of India 51 Voluntary organization 50 service 70 food program 63 health days 73 status of fluoridation 335 Wright’s classification 488 W Yukon children’s dental health program 247 Wash technique 458 Wasting diseases of teeth 434 Water fluoridation 330, 335, 342, 344 purification techniques 38 related diseases 35 soluble vitamins 81 Waxed floss 287 WetBond pit and fissure sealant 391 World bank 70 X Xerostomia and dental caries 320 Y Z Zinc 124 Zone of bacterial invasion 107 decomposed dentine 107 demineralization 107 dentinal sclerosis 107 fatty degeneration 107 caries of dentine 107 ... implementation of oral health education programs that address topics of particular concern to American Indian/Alaska Native populations, such as: • Prevention and cessation of smokeless tobacco use and... contains adequate amounts of fluoride, the ideal preventive dental program would include: Chapter 21 School Dental Health Programs 24 9 Table 21 .2: Examples of oral health- related school health. .. of 6- 12 years have been reached out Teachers Training Program The Teachers Training Program is an integral part of the School Dental Health program which includes the basics of oral health care