Questions and Answers in Community Dentistry Pradnya Kakodkar, Mamatha GS
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Public Health and Dental Public HealthCHAPTER 1

  1. Define public health.
  2. Discuss the changing concepts in public health.
  3. Characteristics of public health method.
  4. Principles/Guidelines followed in dental public health practice.
  5. Characteristics of public health techniques.
  6. Define dental public health.
  7. Functions of public health dentist.
    1. Procedural steps in dental public health.
    2. Define community.
  8. Tools of dental public health.
  9. Similarities between public health dentist and private dentist.
  10. Differences between public health dentist and private dentist.
Public health is defined as: “The art and science of preventing disease, prolonging life and promoting physical and mental efficiency, through organized community efforts; for the sanitation of the environment, the control of communicable infections, the education of the individual in the personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits so as to enable every citizen to realize his birth right of health and longevity.”—Winslow (1920).2
Changing Concepts in Public Health
  1. Disease control phase (1880–1920): Mainly aimed to control man's physical environment, e.g. water supply, sewage disposal, etc. Measures were not aimed to control specific disease but improve the health of the people due to disease and death.
  2. Health promotional phase (1920–1960): It is realized that the public health had neglected the citizen as an individual, to overcome this, one more goal was added, along with disease control activities, i.e. health promotion of individuals. As a beginning, personal health services such as Mother child health services, School health services, and Industrial health services were initiated. This program was further expanded, which included:
    1. Provision of basic health services through Primary Health Centers and sub-centers for rural and urban area.
    2. Community development program to promote village development through the active participation of whole community. However, this failed due to inadequate resources.
  3. Social engineering phase (1960–1980): Many of the acute illness problems were solved but new health problems began to appear, as the preventive medicine and practice of public health advanced. Chronic disease like diabetes, cardiovascular disease, cancer, alcoholism, etc. began to emerge in developed world. These could not be solved by isolation, immunization and disinfections. A new factor “risk factors” as determinants of these diseases came into existence. Social and behavioral aspects of disease and health were given new priority.
  4. Health for all phase (1981–2000 A.D): Most people in the developed countries enjoy all the determinants of good health, in contrast only 10–20% in developing countries have access to health services. It was concluded that the neglected 80% of the world population have an equal claim to health care, protection from killer diseases of childhood and to the primary health care for mothers and children. Against this background, in 1981, the members of WHO pledged themselves to an ambitious target to provide “Health for all by the year 2000;” i.e. attainment for all of a level of health that will permit all people to lead a socially and economically productive life. Here, services were moved from control of communicable diseases to preventive, therapeutic, rehabilitative aspects of chronic disease and behavioral disorders, organization of medical care, safe drinking water, sanitation, nutrition, education, adequate income and comprehensive health care.
3The present form of public health is the combination of scientific disciplines [like epidemiology, Social sciences, demography] and skills and strategies (like epidemiological investigations, planning and management, interventions and surveillance evaluation) that are directed to the maintenance and improvement of the health of the people.
Characteristics of Public Health Method
  1. Group responsibility.
  2. Team work.
  3. Prevention. (It is a major objective because it is ethical, involves team work and is cost effective).
  4. Counteracting medical indigence.
  5. Dealing with multifactorial problem (using the science of epidemiology and biostatistical methods).
  6. Deals with healthy or apparently healthy people as well as the sick.
  7. Health education of the public.
  8. Social sciences.
  9. Logistics.
  10. Insurance/payment.
(Same as answer 3).
Characteristics of Public Health Techniques
The important techniques are:
  1. Use of health center,
  2. Case finding and
  3. Use of community health council.
  1. Health center: These are community buildings to house health administration and a number of out-patient or preventive services not easily housed in a hospital. Usually each center is for 50,000 to 1,00,000 population. Large cities will have many centers. A variant of this health unit in some countries are school based dental clinics.
  2. Case finding: It is also called “Screening”. The objective of this is to search the diseases in the community in their early stage through simple tests.4
  3. Community health council: These councils consists of people in the community from both voluntary and government agencies and community at large. These are associated with community fund raising efforts, interaction with various health agencies and public for development of new ideas. These agencies and councils not only serve as media for communication, but also have approval/disapproval power over both new and existing institutional health services in their areas.
The Council on Dental Education of the American Dental Association has defined dental public health as: “The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice, which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs, as well as the prevention and control of dental disease on a community basis”.
Functions of Public Health Dentist
  1. Conduct health education programs to create awareness among people.
  2. Educating and motivating an individual or community to utilize rendered dental services.
  3. To organize dental camps and delivering dental services for the needy like people in rural areas, orphanages, mentally/physically compromised children, etc.
  4. Conducting school dental health programs and providing preventive dental care to the school children like topical fluoride applications, pit and fissure sealants.
  5. Conducting dental treatment camps and providing treatments like extractions, oral prophylaxis, fluoride applications, simple restorations, ART, etc. in schools or in community for general public.
  6. Updating the knowledge of people regarding new dental preventive methods and procedures.
  7. Conducting surveys to collect baseline data, know the nature and extent of the diseases in the community and plan programs accordingly, to decrease the incidence of the diseases.
  8. Conducting dental public health activities and field experiences for dental students and dental nursing students.
Procedural Steps in Dental Public Health
  1. Survey: Surveys are methods for collection of data, analyzing and evaluating them in order to determine the amount of disease problems in a community and also to identify cases that have not been identified.
  2. Analysis: It is necessary to arrange or organize the data collected from the survey in such a way that meaningful figures are obtained. Analysis can be done manually or using computers.
  3. Program planning: After analyzing the problem, the next step is program planning. The objective is to design the plan so that it is accepted by the community and in which they are interested in, which is comprehensive and cheaper. It has to be ensured that the community is well informed about the program so that they participate in all the steps involved.
  4. Program operation: Execution of the program once the plan has been accepted. A public health team, which constitutes of professionals in various disciplines, has to be employed for executing the program. Example: Water fluoridation, which includes a team of dentists, engineers, chemists, water works department, public health authorities.
  5. Financing: Financing in public health program is usually through the government or by the local or state authorities. Before planning a program, public health personnel should identify the source of funds and also plan for management of the same.
  6. Program appraisal: Final step in any public health program where effectiveness of the program is assessed. The baseline data prior to the introduction of the program serves as an indicator against the effectiveness of the program after the implementation. The criteria for evaluation are appropriateness, adequacy, effectiveness and efficiency.
A community is a definite group of people or population having common organization, living in the same region or area following similar rules and regulations under the same environment.
Tools of Dental Public Health
  1. Epidemiology: Epi = upon, demos = people, logos = science.
    Is defined as “the study of the distribution and determinants of health 6related states and events in population and the application of the study to the control of health problems”. It aims to minimize or eradicate the disease or health problem and its consequences and to minimize the chances of its occurrence in future. It also helps to define the magnitude and occurrence of disease in man, identify the etiologic factors and provide necessary data for planning, implementation and evaluation of programs for preventing, controlling and treating diseases.
  2. Biostatistics: Is a branch of statistics concerned with mathematical facts and data relating to the biological events. It involves compiling, analyzing, tabulating and representing the data in the mathematical or graphical manner. It gives the correlation or association between two attributes.
  3. Social sciences: It includes sociology, cultural anthropology, social psychology, economics and political science. Public health worker when emphasizes on organized community effort, it is necessary to know the group behaviors of individuals, their culture, customs and habits etc. Social scientists are the persons, who play an important role in understanding the group behavior and are necessary to match effort and effect.
  4. Principles of administration: There are two main divisions in administrative work: Organization and Management.
    1. Organization: Which deals with the structure of an agency and the way people are arranged into groups within it.
    2. Management: Concerned with the handling of personnel and operations in such a way that the work of the agency gets done.
  5. Preventive dentistry: Prevention is better then cure, so prevent the disease before it starts. Different levels of prevention are:
    1. Primary prevention: Health promotion (Health education, lobby efforts and research) and Specific protection is protecting the oral cavity from disease before it occurs. (water fluoridation, plaque control, immunization).
    2. Secondary prevention: Disease is in its initial stages. Includes Early diagnosis and prompt treatment (simple restorations, scaling).
    3. Tertiary prevention: Disease is in advanced stage which includes disability limitation (e.g. Root canal treatment, extractions and rehabilitation, e.g. removable or fixed prosthesis, implants, maxillofacial prosthesis).
Similarities Between Public Health Dentistry and Clinical Dentistry
Public health dentistry
Clinical dentistry
  1. Survey: Is done to determine the nature and extent of the problem in the community.
  2. Analysis: It is the procedure of converting collected raw data into meaningful figures using statistical methods to define the characteristics of specific community health problems. Usually professional statistician is involved.
  3. Program planning: Depending on the problem seen in the community, a program is planned, e.g. to decrease the incidence of dental caries, community water fluoridation can be planned.
  4. Program operation: Various groups of disciplines may be needed to be involved to carry out a program and should be accepted by all of them who are involved.
  5. Program funding: Community health programs are financed by local, state or central government or by voluntary organizations, but loss of funds may cause abortment of the plan.
  6. Program appraisal: Data obtained in the initial survey is used as baseline information followed by observing the efficacy, appropriateness and possible side effects.
  1. Examination: It is done when patient comes to dental clinic with a complaint.
  2. Diagnosis: The information collected by examination guides the clinician to obtain accurate diagnosis.
  3. Treatment planning: Once the diagnosis is done clinician will proceed to make plans for the treatment.
  4. Treatment: Actual treatment is carried out on patient, in complicated cases patient is referred to specialist.
  5. Payment: The patient does payment for the treatment immediately after treatment or on monthly basis.
  6. Evaluation: Effectiveness of the treatment is assessed by observing the patient during each visit and by recall.
Differences Between Private Dental Practice and Public Health Dentistry
Private dental practice
Public health dentistry
Individual patient
Whole community
Post pathogenesis
Pre and post pathogenesis
Care provided
Government or other funding agency
Appropriate dental treatment
Preventive measures
Service provider
Services are provided by dentist alone or sometimes with any dental auxiliaries
By health team professionals and para- professionals, community volunteers
Examination method Tools
ADA Type 1 and Type 2 Clinical examination, investigations like radiography, blood tests, biopsies, etc. and treatment
ADA Type 3 and Type 4 Epidemiology, biostatistics, social sciences, principles of administration and preventive dentistry