Principles in Dental Public Health Course



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Principles in Dental Public Health Course

Instructor Guide


This course is designed to introduce the first or second year dental or hygiene students on various aspects and core principles of Dental Public Health, and its application to population based oral health. This course is designed as multiple 1-hour lecture power-point presentations, as well as take-home assignments and/or classroom discussions. Depending on the hours available in the existing curriculum at the dental or hygiene school, any lecture presentation can be used independently or in combination with other presentations and/or take home assignments/discussions. However, some lectures may be most effectively learned in combination. For example, students may better understand the contents in Lecture 2, had they already been exposed to Lecture 1. So it is highly recommended that the instructors review and familiarize themselves with the entire course.
Competencies Addressed:


  1. Describe social and health care systems and determinants of health and their impact on the oral health of the individual and population

  2. Demonstrate the ability to access and describe the use of population-based health data for health promotion, patient care, and quality improvement

The students at the completion of the entire course will be able to:




  1. Identify and describe the principles of public health as it relates to oral health and the dental professional.

  2. Describe the public health and dental public health achievements in the US.

  3. Describe the oral health status and needs of the US population, including various age groups, underserved, and minority populations.

  4. Describe the dental disease trends among various US populations.

  5. Identify and explain determinants associated with heath care access and utilization of dental care services.

  6. Recognize the roles of public, private, professional and voluntary organizations in promoting oral health, and the delivery of dental health care services.

  7. Describe and differentiate different oral health workforce models.



LECTURE 1: Introduction to Dental Public Health
The learning objectives for this lecture are:


  • Define Public Health and Dental Public Health

  • Describe three core functions of public health

  • Describe the ten essential public health services

  • Identify the difference between the roles of a private dental practitioner and a dental public health specialist.

  • List and describe the roles of major federal agencies involved in oral health and dental public health

  • Identify the roles of other professional organizations promoting oral health

In this lecture, the students are first introduced to the principles of dental public health as it relates to oral health and the dental professional. Students will understand the importance of dental public health as a specialty, and how a private dental practitioner can practice dental public health compared to a dental public health specialist. The lecture highlights three major public health functions with examples related to oral health, and ten essential public health services. The lecture also briefly introduces the students to major organizations at the federal level that support and promote dental public health activities. Brief introductions to different professional organizations that believe and support dental public health activities are also included.


Instructions:
Slides 12 to 13 (Example of Assessment), 16 to 17 (Example of Policy Development) and 19 (Example of Assurance) are hidden. Instructors can unhide these slides if they wish to use examples to describe the 3 core public health functions. These examples show how community water fluoridation was adopted in the US, and how the principles of 3 core public health functions were used in the adoption of community water fluoridation in different communities across the nation.

Slides 23-33: These slides extensively discuss the roles of some of the very important organizations under the umbrella of US Department of Health and Human Services (HHS). Instructors may choose to highlight only a few organizations and hide other slides, if needed.

Slides 34-42: In these slides the professional organizations that support dental public health activities are briefly described and discussed. The instructor can highlight only the slide 34, and hide some of the slides between 35 and 42 to elaborate on some of the professional organizations supporting dental public health activities, if needed.

Healthy People 2020: Take Home Activity
For this take home activity, you are expected to visit the Healthy People 2020 website www.healthypeople.gov and understand what Healthy People 2020 goals are all about, and why these goals were set. (You can search and learn from other web resources to understand about HP 2020, besides the above mentioned website). You are expected to write no more than a two-page report for this assignment. List in your report all the “oral health” objectives in the Healthy People 2020 agenda to improve the nation’s health. Please select the two objectives that you think are most, and least, likely to be achieved (or seem the most and least challenging to achieve). Explain your reasoning. To do this you should also visit this website (www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review_focus_area_21.pdf) to understand if some of the objectives were met for the year 2010 (You may review the Healthy People 2010 Oral health objectives from the above highlighted document). In this website, you will find a document: Oral health: chapter 21. In: Centers for Disease Prevention and Control, Health Resources and Services Administration, Indian Health Service, National Institutes of Health. Healthy People 2010.
NOTE: This take home activity may be used in the Oral Health Promotion and Disease Prevention, or Dental Public Health Policy and Advocacy courses, in addition to this course course. This activity can be also introduced after the students have been exposed to Lecture 1, 2, and 3, in that order.

LECTURE 2: Population Based Public Health Strategies
The learning objectives of this lecture enable the students to:


  • Describe the importance of various public health achievements, including dental public health achievements in the last century.

  • Describe the population level impact of community level water fluoridation.

In this lecture, the students are familiarized with the importance of public health practice, and population based care. The lecture explores individually, all the major ten public health achievements of the 20th century, as reported by the Centers for Disease Control and Prevention. Students will understand the prevalence and health effects of certain conditions or diseases in the early 20th century, which decreased or diminished in severity due to adoption of one or more population based health prevention strategies. More detailed information on “Community water fluoridation” as a population based public health prevention strategy is provided. Students will learn about history of water fluoridation, the mechanism by which fluoride acts on tooth structure to minimize dental caries, and the possible side effects of fluoride.


Instructions:

As mentioned above the lecture describes and talks about the major ten public health achievements, including community water fluoridation. The faculty may hide some of the public health achievements, and concentrate on the others. It is recommended that community water fluoridation, as a public health achievement is well stressed and discussed in the class. Another public health achievement that can be stressed and is related to dentistry is “safer workplaces” and how that applies to dental offices.



Take home activity and Class discussion: Identifying a population-based strategy for a community in need.
The student is expected to develop a course of action using the 3 core public health functions, to minimize the effects of the issue at the local, or state or at the national level. The student is asked to assume the role of a dental public health (DPH) professional or a DPH organization, and describe how he/she would adopt one or more population based prevention strategies at the local or state or national level. Some examples of a public health issues are: High levels of smoking on University campuses (local), accidents due to texting and driving (state or national), increase in tooth decay due to availability of carbonated drinks in schools (local, state, or national) etc.
The student will write a one-page report. Please consider the following five questions (but not limited to) and describe the population based preventive strategy that you advise:

1) Whose role (DPH professional or organization) did you take?

2) Describe the one or more prevention strategies you would select to avert or minimize the effects of the PH issue.

3) Please justify why you chose this population based strategy, and

4) What potential limitations and difficulties that may be encountered while adopting such strategies?

5) What are the possible short term and the long term outcomes (positive and negative) that you will expect after implementing the strategy?


The faculty may choose a few well-written reports to discuss in the next class. All students should be prepared to present their report in the class. It is recommended that the faculty select 5 to 6 reports (depending on the available time) that may initiate a wide range of discussion and the respective students will present their report in front of the whole class. Faculty should be able to discuss the potential positive and negative consequences of various strategies proposed in the reports. This activity can also be assigned as a group project as well.
NOTE: For the students to effectively complete this take home activity and participate in the class discussion actively, they should already be familiar with BOTH Lectures 1 and 2. This take home activity may be used in the Oral Health Promotion and Disease Prevention and, Dental Public Health Policy and Advocacy courses, in addition to this course.
NOTE: The lecture presentation, take home activity and the class discussions all together combined may take 3 hours. Some of the slides have animations. The order of animations is aligned with what instructors are recommended to say for that slide. Slides with animations also have a detailed speaker’s note. Instructors are recommended to review and familiarize with the slides and speaker’s notes.

LECTURE 3: Oral Health Status and Disparities in the US.
The objectives of this lecture are to make the students:


  • Describe the current oral health status of the US population

  • Describe what oral health disparities mean

  • Describe various factors associated to oral health disparities among US population

Students will understand about few important oral health indicators, and how they are used to measure the overall oral health status of different population subgroups in the US. A brief review of the Healthy People 2020 Oral Health objectives related to maximizing oral health in the US will be addressed. In this lecture, students will understand what “disparity” means in context to oral health status and utilization of dental care. Reasons why there is a disparity in oral health status and utilization of dental care among different subgroups of population will be discussed. This lecture also focuses on one such factor, “shortage and geographical preferences” of dental workforce in the US, that may be associated with oral health disparities among the underserved.


Take home activity: Oral Health Needs Assessment and Disparities Project.
Students will use data from the Centers of Disease Control and Prevention’s (CDC) National Oral Health Surveillance System (NOHSS) website [http://www.cdc.gov/nohss] to prepare a presentation highlighting the oral health disparities in a selected population group. This is a group project, and instructors are recommended to assign 6 to 8 students per group to complete the task.


  1. Students will select a minimum of 3 out of the 9 oral health indicators listed in the website. [http://www.cdc.gov/nohss].

  2. Students will identify and describe the oral health status of the people in a State based on the selected 3 oral health indicators (using the most recent data) and compare it to the overall U.S national estimates. Alternatively, they may compare oral health indicators between two different time periods. For example, students can compare the most recent data (2008) on dental visits, to the previous periods (2006, 2004, 2002 etc). Or compare between two different states for the same time period. For example, students can compare the 2008 dental visits data for Florida and Ohio, and determine people in which state had lower dental visits.

  3. The student should describe whether there are any major differences in oral health status (or otherwise oral health disparities) based on age, gender, race and income.

  4. Students will also review this website [http://kff.org/other/state-indicator/dental-care-health-professional-shortage-areas-hpsas] to understand dental workforce shortage concerns in their state. They are advised to look at dental workforce shortage areas (if any), and additional dental workforce needed if any).

  5. Students will write a one-page report, compile the data together in a table format, interpret the data and justify if there is a need for programs


NOTE: The take home activities may be used in other courses such as Oral Health Promotion and Disease Prevention, and Ethics and Dental Public Health.
NOTE: The lecture presentation, and the take home activity combine together may take 2 hours. Some of the slides have animations. The order of animations is aligned with what instructors are recommended to say for that slide. Slides with animations also have a detailed speaker’s note. Instructors are recommended to review and familiarize with the slides and speaker’s notes.

LECTURE 4: Access to dental care and utilization of dental services
The objectives of this lecture are to make the students:


  • Define and describe concepts, and measures of access to dental care & utilization of dental services

  • Recognize the issues (problems) with access to dental care in the US, especially among underserved and vulnerable population groups

  • Identify factors associated with access to dental care and utilization of dental services and discuss ways to modify them to improve access and utilization

In this brief lecture, students will understand what access to dental care is, and possible factors leading to access to dental care issues among certain subgroups of US population. This lecture highlights the importance of access to dental care, and various health, economic and social consequences the public faces due to lack of access to dental care. Students will understand that access to dental care is multifactorial in nature, and in detail will also understand how certain issues like shortage of dentists, inadequate funding, and no or inadequate insurance coverage may lead to differential experiences in accessing adequate dental care among different subgroups. The students are also briefly explained about Affordable Care Act or the ObamaCare act.


NOTE: Slides from this lecture can be used in other lectures. For example, slides 127 to 130 can be used as supplemental slides for Lecture 5. Some slides related to “access to dental care” could also be used in Lecture 3. Slides 109 to 115 from the oral health disparities lecture can also be used in this lecture to show how access to dental care is influenced by geographical locations where dentists practice.

LECTURE 5: Dental Care Delivery Systems
The objectives of this lecture are:


  • Describe different kinds of vehicles for dental care delivery in the US

  • Identify the roles and scope of various dental and non-dental care delivery models.

  • Understand different dental care delivery sites operated by federal, state and local governments

  • Describe different types of common payment services for dental services

In this lecture the students are introduced to the US dental care delivery systems that comprise of different vehicles of dental care delivery, financing and organizations related to financing of dental care, and the dental workforce that delivers quality dental care. Also in this lecture, is information needed for students to understand the need for new dental care delivery models in the US. New expanded dental care workforce models and non-dental workforce models and their scope of dental practice are briefly discussed. Dental care delivery vehicles at the local, state, and especially at federal levels are highlighted and stressed. Federal government’s role in delivery of dental care, and different federally qualified health centers where majority of underserved population receive dental care are highlighted. The students learn about the most common forms of reimbursements methods received from insurance companies, and major insurance companies and managed care organizations that support financing dental care delivery.



Instructions:

Slides 154-63, describe different vehicles or sites, governed by federal government, where dental care services are provided to different underserved groups. Again instructors may choose to hide some of the slides or use all examples, if needed.



Take home activity/group discussion: Workforce Models

Working in groups (6 to 8), students will be assigned to research one of the proposed alternative dental provider models. Which model each group is to research on is selected by the instructor. Students will develop a power point presentation, of not more than 10 minutes long on their assigned model and present to classmates in the next class. Working groups will be randomly picked by the instructor, based on the workforce models they were assigned, and asked to present in front of the entire class. At least 4 working groups will be able to present with 5 minutes for questions and discussion Students will address the following points:




  1. History of the model and its implications,

  2. Impact on the delivery of care, education, licensure, scope of practice, regulation,

  3. Evolution of the model,

  4. Pros and cons of the model.

  5. Identify supporters and opponents of the model, if any



Classroom activity/discussion: Invite a representative from one of the Federal or State organization that offers loan repayment to speak to the class about opportunities in the public sectors





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