Textbook of Public Health Dentistry

PART 1 PUBLIC HEALTH

1 Concepts of Health and Disease and

Prevention, 3

Manjunath P Puranik

Introduction, 3

Changing Concepts of Health, 3

Defi nitions of Health, 4

Dimensions of Health, 4

Concept of Wellbeing, 5

Spectrum of Health, 5

Determinants of Health, 5

Responsibility for Health, 7

Indicators of Health, 7

Health Service Philosophies, 9

Concept of Disease, 11

Concept of Causation, 11

Natural History of Disease, 12

Disease Classifi cation, 13

Changing Pattern of Disease, 13

Community Diagnosis and Treatment, 13

Concepts of Control, 14

Concepts of Prevention, 14

Modes of Intervention, 15

2 General Epidemiology, 17

Prithvish | BS Nanda Kumar

Introduction, 17

Epidemiology and Clinical Medicine, 17

Scope of Epidemiology, 18

Epidemiology in Different Settings, 18

The Epidemiologic Triad, 18

Measurements in Epidemiology, 19

Epidemiological Methods, 22

Analytical Studies, 24

Association, Relationship and Causation, 27

Uses of Epidemiology, 27

Screening for Dental Disease, 28

Investigation of an Epidemic, 31

3 Environmental Health, 34

Prithvish | K Pushpanjali

Defi nition of Environmental Health, 34

Components of Environmental Health, 34

General Impact of Environment on Health, 34

Specifi c Environmental Health Effects, 34

Methods of Identifying Environmental Pollution/

Contamination, 35

Differences between Eradication, Control and

Elimination of Environmental Health Hazards, 35

Pollution Control, 35

1. Air Pollution, 35

2. Noise Pollution, 37

3. Water Pollution, 40

Solid Waste Management, 47

Introduction, 47

Disposal of Wastes, 48

Solid Wastes, 48

Occupational Hazards Associated with Waste

Handling, 53

Public Education, 53

4 Health Education, 57

Dara S Amar | Anitha R Sagarkar

Introduction, 57

Defi nition, 57

Principles of Health Education, 57

Approaches to Public Health Education, 58

Concepts of Health Education, 59

Nature of Learning, 59

Methods of Health Education, 59

Characteristics of an Effective Health Education, 63

Communication, 63

Barriers to Communication, 63

Health Education and Propaganda, 63

5 Primary Health Care, 65

Shivram | Anitha R Sagarkar

Introduction, 65

Alma-Ata Declaration 1978, 65

Primary Health Care, 66

Principles of Primary Health Care, 66

Staffi ng Pattern, 68

Functions of PHC, 68

Reasons for Lack of Primary Dental Care, 69

6 National Health Programmes, 70

Hiremath SS

Introduction, 70

National Health Programmes in India, 70

Nutritional Programme, 75

Pilot Project on Control of Cardiovascular Diseases

and Stroke, 77

National Programme for Prevention and Control

of Diabetes, Cardiovascular Disease and Stroke

(NPDCS), 77

7 International and National Health Agencies, 80

Hiremath SS | Anitha R Sagarkar

Introduction, 80

Objectives, 80

Quarantine, 80

International Health Agencies, 81

Indian Voluntary Health Agencies, 84

8 Hospital Administration, 88

Narendranath V

Introduction, 88

Change of Role as Health Administrator, 88

Importance of Hospital Administration, 88

Importance of Hospital Management, 88

Hospital as a System, 89

Legal Aspects of Private Practice, 90

Quality in Dental Practice and Accreditation, 90

NABH Standards for Dental Facility, 91

9 Behavioural Sciences, 93

Dara S Amar | Sushi Kadanakuppe

Introduction, 93

Defi nition, 93

Components, 93

Categories of Behavioural Sciences, 93

Scope and Use of Behavioural Science in Dental

Health, 93

Sociology, 94

Psychology, 94

Social Psychology, 96

Conclusion, 97

Anthropology, 97

PART 2 DENTAL PUBLIC HEALTH

10 Introduction to Dental Public Health, 103

Manjunath P Puranik

Introduction, 103

History of Dentistry, 103

Planning Dental Care, 105

Scope of Dental Care, 105

Public Health, 105

Dental Public Health, 107

Functions of Public Health Dentist, 108

Roles of Dental Public Health Workers, 109

Achievements of Dental Public Health

Professional, 109

11 Epidemiology of Dental Caries, 111

Hiremath SS | Sushi Kadanakuppe

Introduction, 111

Epidemiological Studies, 111

Indian Scenario, 112

Global Scenario and Current Trends in Caries

Incidence, 112

Epidemiological Factors of Dental Caries, 113

I. Host Factors (Demographic Factors), 113

II. Agent Factors, 115

III. Environmental Factors, 115

12 Epidemiology of Periodontal Diseases, 118

Hiremath SS

Introduction, 118

Epidemiology of Periodontal Disease, 118

Epidemiologic Studies, 118

National Oral Health Survey and Fluoride Mapping

2002-2003 (Conducted by Dental Council of

India), 119

Aetiology of Periodontal Disease, 120

Pathogenesis of Periodontal Disease, 122

Epidemiologic Factors, 123

13 Epidemiology of Oral Cancer, 126

Hiremath SS

Introduction, 126

Global Scenario of Oral Cancer, 126

Spectrum of Oral Cancer in India, 127

Epidemiological Studies, 127

Age Distribution, 128

Gender Distribution, 128

Ethnic Basis, 128

Site Distribution, 128

Trends, 128

Aetiology and Risk Factors, 128

Classifi cation of Oral Cancer, 130

Clinical Presentations of Cancer of Oral

Mucosa, 132

Diagnosis of Oral Cancer, 132

Treatment of Oral Cancer, 133

Prevention and Control of Oral Cancer, 133

Role of Dentist in Detecting and Preventing Oral

Cancer, 136

Population-Based Cancer Registries: Invisible Key to

Cancer Control, 136

14 Oral Health Education, 139

Manjunath P Puranik

Introduction, 139

Considerations in Oral Health Education, 139

Nature of Learning, 140

Educational Process, 140

Communication, 141

General Educational Theories, 142

Basic Concepts of Oral Health Education, 143

Approaches in Oral Health Education and Health

Promotion, 145

15 Nutrition and Oral Health, 147

Pushpanjali K | Ranadheer R

Introduction, 147

Nutrition, 147

Classifi cation of Nutrients, 147

Recommended Dietary Allowances, 151

Assessment of Patient's Nutritional Status, 151

Dietary History and Evaluation, 151

Diet Counselling and Dietary Advice, 152

16 Surveying and Oral Health Surveys, 155

Manjunath P Puranik

Surveying, 155

Introduction, 155

Steps in Survey, 155

Oral Health Surveys, 158

Pathfi nder Surveys, 158

Subgroups, 158

Index Ages and Age Groups, 158

Number of Subjects, 159

Organizing the Survey, 159

Reliability and Validity of Data, 160

Implementing the Survey, 160

Survey Form, 160

17 Indices, 162

Hiremath SS | Archana Krishnamurthy

Introduction, 162

Defi nition of Index, 162

Objective of an Index, 162

Properties of an Ideal Index, 162

Purpose and Uses of an Index, 163

Selection of an Index, 163

Types of Indices, 163

18 Dental Auxiliaries, 184

Hiremath SS

Introduction, 184

Rationale for Training and Use of Dental

Auxiliary, 184

Defi nition, 184

Classifi cation, 185

Effects of Auxiliaries on Dental Education, 186

Interesting to Know, 187

Dental Manpower Planning, 187

Benefi ts of Using Auxiliaries, 188

Impact of Auxiliaries in Indian Scenario, 188

19 Financing Dental Care, 190

Manjunath P Puranik

Introduction, 190

Structure of Dental Practice, 190

Insurance and Dental Care, 191

Classifi cation of Payment Plans, 192

Public Financing of Health Care, 195

State Children's Health Insurance Programme

(Schip), 196

Indian Scenario, 196

20 Dental Needs and Resources, 199

Manjunath P Puranik

Introduction, 199

Dental Needs, 199

Demand for Treatment, 200

Manpower, 201

Scope of Service, 201

Matching Programmes to Need and Demand, 201

21 Planning and Evaluation in Oral Health, 203

Manjunath P Puranik

Introduction, 203

Types of Health Planning, 203

Planning of Dental Health Services, 203

Planning for Community Dental Programmes, 205

Rational Planning Model, 207

Evaluation, 207

22 School Dental Health Programmes, 210

Hiremath SS

Introduction, 210

Health Promoting School, 210

Importance of Oral Health in Children, 210

Importance of Schools in Promoting Oral

Health, 211

Planning a School Dental Health Programme, 211

Oral Health Education Programmes, 213

School Based Preventive Programmes, 215

Referral for Dental Care, 216

School Lunch Programme, 216

Incremental Dental Care, 217

Evaluation, 217

23 Dental Practice Management, 219

Shankar Aradhya MR | Shilpashree KB

Introduction, 219

Factors Associated with Successful Dental

Practice, 219

24 Ethics in Dentistry, 224

Manjunath P Puranik

Introduction, 224

Ethics and Human Conduct, 224

Ethics and Social Sciences, 224

Evolution of Medical Ethics, 225

Basis for Medical Ethics, 225

Principles of Ethics, 225

Ethical Rules for Dentists in India, 226

25 Dentist Act-1948, 228

Manjunath P Puranik

Introduction, 228

Effect of Registration, 231

Miscellaneous, 231

The Dentists (Amendment) Act, 1993, 233

26 Dental Council of India (DCI) and Indian

Dental Association (IDA), 236

Hiremath SS | Sowmya KR

Dental Council of India, 236

Introduction, 236

Defi nitions, 236

Constitution of the Council, 237

Mode of Elections, 237

The Executive Committee, 237

Recognition of Dental Qualifi cation, 237

Qualifi cation of Dental Hygienists, 238

Qualifi cation of Dental Mechanics, 238

Preparation and Maintenance of Register, 238

The Indian Dental Association (IDA), 238

Management of the Association, 239

27 Consumer Protection Act, 241

Hiremath SS | Sowmya KR

Introduction, 241

Supreme Court Decisions of the Consumer Protection

Act, 242

Defi nitions, 242

Consumer Redressal Forums and Commissions, 242

of Compensation, 243

Powers of Consumer Redressal Forums and

Commissions, 243

Who Can Sue the Doctor Under CPA?, 243

Against Whom Can a Complaint be Filed?, 243

Who are Exempted?, 244

What Should You Do When You Receive a

Complaint?, 244

What is a Complaint?, 244

Time Limit to File a Complaint, 244

Guidelines to be Adopted to Avoid Needless

Litigations, 245

Consent, 245

Salient Features of Consumer Courts, 246

Consumer Protection Act and Patients, 246

Consumer Protection Act and Doctors, 246

Limitation of Consumer Forum, 246

28 Forensic Odontology, 248

Pushpanjali K

Introduction, 248

History, 249

Common Reasons for Identifi cation of Found Human

Remains, 249

Principles of Dental Identifi cation, 250

PART 3 PREVENTIVE DENTISTRY

29 Introduction and Principles of Preventive

Dentistry, 261

Hiremath SS

Concepts of Preventive Dentistry, 263

Scope of Preventive Dentistry, 263

Principles of Preventive Dentistry, 263

30 Dental Caries, 265

Hiremath SS | Sushi Kadanakuppe

Introduction, 265

Early Theories of Caries Aetiology, 266

Current Concepts of Caries Aetiology, 267

Microbiology of Dental Caries, 268

Mechanism of Adherence of Microorganisms to Tooth

Surface, 269

Formation of Plaque, 269

Role of Saliva in Dental Caries, 269

Classifi cation of Dental Caries, 270

Clinical Manifestations of Dental Caries Process, 273

Caries of Enamel, 274

Dentinal Caries, 276

Root Caries, 276

31 Diet and Dental Caries, 278

Hiremath SS

Introduction, 278

Food, 278

Diet, 278

Nutrition, 278

Components of Foods, 278

Classifi cation of Carbohydrates, 278

Evidence Linking Diet and Dental Caries, 279

Cariogenicity of Sucrose, 280

Stephan Curve (1940), 281

Oral Clearance of Carbohydrates I, 281

Preventive Dietary Programme, 282

Dietary Counselling, 282

Tooth-Friendly Snack or Ideal Snack, 283

Sugar Substitutes, 283

Functions of Sugar in Food Technology, 283

Classifi cation, 283

Diffi culties in Substitution of Sucrose, 284

32 Caries Risk Assessment, 285

Hiremath SS | Archana Krishnamurthy

Introduction, 285

Risk Group, 285

Factors Relevant for Assessment of Caries Risk, 286

Clinical Evidence, 287

Identifying Relevant Risk Factors, 287

Caries Risk Assessment Tools, 287

Caries Diagnosis and Lesion Detection, 288

33 Caries Activity Tests, 290

Hiremath SS

Introduction, 290

Caries Activity Tests, 290

Mutans Group of Streptococci Screening Tests, 292

Uses, 293

34 Cariogram, 294

Hiremath SS

Cariogram-The Five Sectors, 294

"Chance to Avoid Caries", 295

Principles of Caries Risk Estimation Based on

"Cariogram" Concept, 295

Using the Cariogram for Evaluation of Caries

Risk, 298

35 Dental Caries Vaccine, 300

Hiremath SS

Introduction, 300

Prospects for Vaccination Against Dental Caries, 301

Route of Administration of Vaccine, 301

Effective Molecular Targets for Dental Caries

Vaccine, 302

Synthetic Peptide Vaccines, 302

Risk Factors, 303

Past, Present and Future Human Applications, 303

36 Fluorides, 306

Hiremath SS

Introduction, 306

Water Fluoridation, 306

Physiology and Chemistry of Fluoride, 309

Fluoride Homeostasis, 309

Fluoride Biomarkers, 312

Mechanism of Action of Fluoride, 313

Classifi cation of Fluoride Therapy, 315

Dental Fluorosis, 324

Defl uoridation, 326

Reports from Who on Appropriate Use of Fluorides

for Human Health, 328

37 A Global Perspective on Application

of Fluoride Technology, 330

Amit Chattopadhyay | Jayanth V Kumar | Astha Singhal

Introduction, 330

Global Variation in Fluoride Delivery, 330

Balancing Benefi ts and Risks of Fluoride, 330

Water Fluoridation Globally, 331

Salt Fluoridation in the World, 334

Milk Fluoridation in the World, 334

Global Fluoride Toothpaste Usage, 334

Inequality in Oral Health and Fluoride Policy, 335

Developing Policy on Fluoride, 336

38 Oral Hygiene Aids, 340

Hiremath SS | Sushi Kadanakuppe

Introduction, 340

Manual Tooth Brush, 340

Powered Toothbrushes, 342

Dental Floss, 344

Interproximal and Unitufted Brushes, 345

Wooden or Plastic Triangular Sticks, 346

Tongue Cleaners, 346

Rinsing, 346

Irrigation Devices, 347

Dentifrices and Mouth Rinses, 347

39 Pit and Fissure Sealants, 352

Hiremath SS

Introduction, 352

Defi nition, 353

Types of Fissure System, 353

Types of Pit and Fissure Sealants, 353

Requisites for Sealants Retention, 355

Patient and Tooth Selection, 355

Technique for Sealant Application, 356

Follow-Up and Review, 358

Minimally Invasive Preventive Restorations Preventive

Resin Restoration (PRR), 358

Sealing of Carious Fissures, 358

Sealants Versus Amalgams, 359

Cost Effectiveness of Fissure Sealants, 359

Sealant as Part of a Total Preventive Package, 360

Present Status of Pit and Fissure Sealants, 360

40 Atraumatic Restorative Treatment, 362

Hiremath SS | Renuka Piddennavar

Introduction, 362

Principles, 362

Contraindications, 363

Survival of Art Restorations, 363

Tips on Working, 363

Modifi ed Art, 368

Art: Important Guidelines, 369

41 Minimal Invasive Dentistry (MID), 370

Hiremath SS | Ramya R Iyer

Introduction, 370

Defi nition, 370

Principles of Minimally Invasive Dentistry, 371

Rationale of the Mid Philosophy, 371

Procedures in Mid, 371

42 Prevention of Dental Caries, 377

Hiremath SS | Ramya R Iyer

Introduction, 377

Caries Preventive Methods and Means, 377

Dietary Measures, 377

Oral Hygiene Measures, 380

Fluoride and Different Vehicles to Provide

Fluoride, 380

Arginine and Dental Caries Prevention, 383

Antimicrobial Agents and Treatments, 383

Remineralizing Agents, 384

Salivary Stimulation, 384

Fissure Sealants, 385

General Recommendations for Prevention of Dental

Caries with Respect to Use of Sugars, 385

Recommendations (For Children at High Risk of

Dental Caries), 386

43 Prevention of Periodontal Diseases, 388

Hiremath SS

Introduction, 388

Implications for Prevention, 388

Factors Predisposing to Plaque Accumulation, 388

Oral Hygiene Aids, 391

Chemical Plaque Control, 392

44 Prevention of Malocclusion, 396

Hiremath SS

Introduction, 396

Prevalence of Malocclusion, 396

Aetiology of Malocclusion, 396

Need for Defi nite Orthodontic Treatment, 398

Preventive Measures, 399

Interceptive Measures, 400

Scope and Limitations of Interceptive

Orthodontics, 401

45 Prevention of Dental Trauma, 402

Hiremath SS

Introduction, 402

Prevalence of Dental Trauma, 402

Etiology, 402

Predisposing Factors, 402

History and Examination, 403

Prevention of Dental Traumatic Injuries, 403

Primary Protection, 403

Secondary Prevention, 404

Tertiary Prevention, 405

46 Occupational Hazards in Dentistry, 407

Pushpanjali K | Shwetha KM

Introduction, 407

Occupational Hazards, 407

Disorders of Musculoskeletal and Diseases of

Peripheral Nervous System (PNS), 411

Recommendations, 412

47 Infection Control in Dental Care Setting, 413

Hiremath SS | Pushpanjali K

Introduction, 413

Infection Control Procedures, 414

Disinfection and Dental Laboratory, 420

Health Care Waste Management, 420

Lead Management, 421

Mercury Spill Management, 421

Dental Health Care Waste Management, 421

48 Evidence-Based Dentistry, 424

Hiremath SS | Ramya R Iyer

Introduction, 424

Steps in Evidence-Based Dentistry, 424

Evidence-Based Public Health, 426

49 National Oral Health Programme:

Overview, 428

Vijay Prakash Mathur | Vartika Kathuria Monga

Background, 428

History, 428

Need for Oral Health Policy, 428

Draft for Oral Health Policy, 429

Pilot Project on National Oral Health Care

Programme, 429

National Oral Health Programme, 430

PART 4 RESEARCH METHODOLOGY

AND BIOSTATISTICS

50 Scientifi c Research Methods in Public Health

Dentistry, 435

Amit Chattopadhyay

Introduction, 435

Scientifi c Research Process, 436

Study Types and Designs, 436

A Brief Note on Sampling, 439

Responsible Conduct of Research, 439

Publishing Research Results, 440

51 Biostatistics, 441

Shivaraj NS

Introduction, 441

Presentation of Data, 441

Sampling Techniques, 442

Descriptive Statistics, 444

Statistical Inference, 446

Testing of Hypothesis, 447

Correlation and Regression, 448

APPENDICES

A Defi nitions and Glossary, 453

B WHO Oral Health Assessment Proforma

(1997), 463

C WHO Oral Health Assessment Form (2013), 468

D Case History Proforma, 477

E Levels of Prevention, 482

F Tobacco Use, Effects on Health and

Management, 484

G Fluoride Fact, 490

Index, 493

Online Lecture Notes on Important