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Dental public health VII (100 Flash cards)
Fichas del conjunto (100)
- 1What kind of studies provide evidence for a relationship between diet and dental caries?Animal experiments
Human observational studies
Human interventional studies (clinical trials) - 2What did the Bernabe et al study show?That drinking sugar sweetened beverages regularly increased the incidence of caries even when tooth brushing with a fluoride toothpaste
- 3What is an example of a human interventional study that provides strong evidence for an association between diet and disease?Vipeholm study
- 4What are key pieces of evidence that show increased sugar intake increase caries prevalence?Caries are higher in communities with greater sugar intake
Caries prevalence increases when sugar is introduced to isolated communities
Caries decrease when sugar is restricted e.g. war - 5What are the coma classifications of sugar?Intrinsic and extrinsic sugars
- 6What are extrinsic sugars further classified into?Milk sugars
Non-milk sugars - 7What are free sugars?Mono- and disaccharides added to foods by age manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit concentrates
Does not include sugars in dairy products - 8What is the recommended intake of free sugar?Should not exceed 5% of the total dietary intake i.e. around 30g per day
- 9How much free sugar does a single carbonated drink contain (330ml)?26g
- 10What is considered a low/high sugar content?>15g per 100 gram is high
<5g per 100g is low - 11What is the current sugar guidance?Reduce intake and frequency
Drink water or milk
Sugar free snacks
Do not eat after brushing - 12What two sugar variables are the most important determinants of caries prevalence?Amount and frequency
- 13What is the difference between clinical exams and epidemiological studies?C.E: looks at the individual and diagnoses patient
E.S: looks at a population and records prevalence of caries - 14How is the level of caries classified?Sound surface
D1: enamel caries, no cavitation
D2: cavity in enamel only
D3: clinically detectable caries into dentine - 15What is the order of precedence of the DMFT index?Missing
Decayed
Filled - 16At what level is restorative treatment indicated?D3 level
- 17Why is the D3 level used?Inter-examiner and intra-examiner reliability
- 18What is the indicator of treatment need?% of caries that are untreated
- 19What is the care index?The percentage of caries that have been restored
- 20What are the limitations of the DMFT?Each component has equal weight index but unequal impact on the patient
Not ideal for the mixed dentition
Teeth may be missing for other reasons than disease
Fillings may have been placed for trauma - 21What is the national dental inspection programme?Programme that looks art primary school children's teeth annually
- 22How does the NDIP classify children?Urgent dental problem
Care needed
No obvious problems - 23What data does the NDIP report yield?Geographical comparisons of oral health
Average number of DMFT
% of decay free children - 24What percentage of children showed no obvious decay in the 2017-2018 report?71%
- 25What effects can caries have?Pain
Infection
Tooth loss
Ability to eat
Mental health
Ability to sleep - 26What effects do caries have on the population?Treatment needs
Most common reason for a child to have a GA
School absences
Work absences - 27How many working days are lost each year due to caries?12-15 million
- 28How much did the general dental service cost in 2018?£409 Million
- 29How much did the public dental service cost in 2018?£40 million
- 30What were the total and average dental fees in Scotland in 2017-18?Children: £75 million (£73 average)
Adults: £215 million (£49 average) - 31What are the benefits of the common risk factor approach?Value for money by tackling multiple problems
More consistent message
Greater impact of multiple agencies join together - 32What are examples of the common risk factor approach?Smoking legislation
Minimum unit pricing
Sugar tax - 33What are examples of investment in improving oral health?Childsmile
- 34What are clinical guidelines?Systematically developed recommendations on how healthcare and other professionals should care for people with specific conditions based on the best available evidence
- 35What are the purposes of clinical guidelines?Accelerate the translation of new knowledge into action
Reduce variations in practice
Improve patient-important outcomes - 36What is a systemic review?A replicable, scientific and transparent process that summarises the results of available carefully designed healthcare studies and provides a high level of evidence on the effectiveness of healthcare interventions
- 37What are benefits of systemic reviews?Reduces researcher bias and demands the researcher is comprehensive in their approach
Highlights where there is not enough evidence
Can reduce the influence of flawed single studies - 38What are features of a good systemic review?Answers a defined research question
Transparency and replicability of methods - 39What are examples of transparency?Data sources
Conflicts of interest
Exclusion/inclusion criteria - 40What does a meta-analysis do?Combines the results of individual studies in a systemic review to produce and overall statistic
- 41What is the purpose of a meta-analysis?More precise estimate of the effects of intervention
Reduces uncertainty - 42What does the solid vertical line in the centre of a forest plot represent?What does the solid vertical line in the centre of a forest plot represent?
- 43What are the limitations of systemic reviews and meta-analysis?May soon become outdated
May be poorly conducted or reported - 44What are the components of evidence based dentistry?Dentists expertise
Scientific evidence
Patient needs and preferences - 45What are criteria of high quality guidelines?Have clear scope and purpose
Be evidence based
Include end users and patients in development
Be bias-free
Subject to public consultation
Developed by qualified individuals - 46Why is diagnosing and treating periodontitis important from a legal standpoint?Medico-legal defence unions are reporting an increasing number of claims related to alleged failure to diagnose and treat periodontitis
- 47What does the PICO acronym stand for?Patient, population or problem
Intervention
Comparison
Outcome - 48What should the PICO format be applied to?Clinical questions
- 49What are benefits of topical fluoride delivery?Inhibits demineralisation
Promotes remineralisation - 50What are problems of fluoride?Fluorosis
Mottling - 51How do fluoride ions affect the critical pH?Forms fluorapatite which has a critical pH of 4.5
- 52How does fluoride interact with apatite?Stabilises crystal structure
Lowers critical pH - 53What are the effects of fluoride on oral bacteria?Passes through bacterial membranes
Inhibits enzymes in the glycolysis pathway
Inhibits storage of intracellular poly-saccharides
Toxic to bacteria - 54What are the degrees of fluorosis?Mild- fine white lines
Moderate- opaque discoloured enamel
Severe- loss of enamel - 55How does fluorosis occur?Reduced enamel matrix protein degradation
Incomplete crystal growth - 56How can fluoride be delivered?Passive: water, salt, milk
Active: toothbrushing, varnish, tablets - 57What fluoride levels are of no public health significance?1ppm
- 58When was fluoridation recommended in the UK?1952
- 59When did fluoridation start in the UK?1955
- 60What were the outcomes of the strathclyde case?Fluoridation is beyond the legal powers of the council
Fluoride at 1ppm is not mutagenic
Not likely to cause cancer
No link to increased deaths
Fluoridation likely reduces caries - 61What did the judge dismiss in the strathclyde case?Fluoridation is a breach of the water act and the council would be failing in their legal duty to provide a supply of wholesome water
It would be unlawful for the council to provide a medicinal product without having a product license - 62What are the claims of the negative effects of fluoride?Fluorosis
Cancer
Hip fracture
Downs syndrome - 63What is the fatal dose of fluoride?32-64mg/kg
- 64What are examples of fluoride related deaths?3 yr old boy swallowed 45ml of 4% snf and died 3 hours later
- 65At what concentration does skeletal fluorosis develop?Over 8ppm
- 66Name 2 major systemic reviews of fluoridation2015 Cochrane review
2000 York systemic review - 67What should be considered when making ethical decisions about fluoridation?Autonomy: patients right to refuse treatment
Beneficence: act in the patients best interest
Dignity
Truthfulness and honesty: informed consent
Non-maleficence: do no harm
Justice: fair spread of treatment - 68How does fluoride reduce decay?Creates shallower pits and fissures
Remineralises early caries and reduces demineralisation
Interferes with bacterial metabolism - 69By how much can tap water fluoridation reduce caries?60%
- 70What are the advantages of fluoride varnishes?43% reduction of caries in the permanent dentition
37% reduction of caries in the primary dentition
Effective for high risk patients - 71What are the disadvantages of fluoride varnishes?More costly than self applied
Require healthcare professionals to apply - 72What fluoride varnish is used in the UK?Duraphat
- 73What is the dosage of duraphat?0.25ml for children under 6
0.4ml for children over 6 - 74What is the sodium fluoride concentration of duraphat?2.26%
- 75What advice is given to patients following application of duraphat varnish?Do not eat or drink for 30 mins
Eat soft food for the rest of the day
Don't brush teeth that day
Patients teeth may be temporarily discoloured - 76What are signs of acute fluoride toxicity?Stomach irritation, nausea and vomiting
- 77How should a child suspected of ingesting excessive levels of duraphat?Given a glass of milk and then taken to A&E
- 78What are the disadvantages of fluoride gels?Less effective than varnishes
Cannot be used on children less than 6 - 79What are common fluoride compounds in toothpaste?Sodium fluoride
Sodium monoflurorphosphate
Amine fluoride - 80Who can use high fluoride toothpastes (2800-5000ppm)Children over 10yrs old
- 81Who can use high fluoride toothpastes over 5000ppm?Children over 16
- 82What are the main guidelines on prescribing high fluoride toothpastes?They should be accompanied by assessment of caries risk factors
Be on a short term basis
2800ppm should be used first unless the level of clinical need is very high - 83When is the risk of developing dental fluorosis on the permeant incisors greatest?During the first three years of life
- 84What is caries risk?The probability of an individual developing at least a certain number of carious lesions reaching a given stage of disease progression during a specific period
- 85What does the DEPCAT score show?Social deprivation categories
- 86What are the three evidence based indicators that a child is likely to develop new dental caries?Deprivation
Existing Caries
Clinicians intuition - 87What teeth are most at risk of carious lesions?Lower incisors
- 88How are caries scored?0-6 using the international caries detection and assessment system (ICDAS)
- 89What factors can cause xerostomia?Medications such as antidepressants and antipsychotics
Head and neck radiotherapy - 90How is an individuals oral hygiene rated?Silness and Löe plaque index
0: no plaque
1: plaque visible on probe
2: plaque visible with the naked eye
3: plaque visible all around the tooth - 91What is the name of the island where sugar was imported in 1940?Tristan da Cuhna
- 92What are the big 4 of chair side prevention?Brushing advice
Diet advice
Topical Fluorides
Fissure sealants - 93the definition of public health by the WHOeffort to promote physical and mental health, prevent disease, injury and disability at the population level
- 94the definition of public health by the American public health associationpeople's health with concern and activities directed toward improvement and protection of the health of a population
- 95OVERALL goals of public healthhealth protection, disease prevention, and health promotion
- 96focus on health of a population as a ____ vs _____whole vs individual
- 97the emphasis is on prevention at all levels:primary, secondary, and tertiary
- 98examples of primary preventioncommunity water fluoridation, dental hygiene education (brushing and flossing)
- 99definition of primary preventionemployment of strategies and agents to forestall the onset of disease, reverse or arrest its progress before treatment becomes necessary
- 100examples of secondary preventionfluoride therapy to remineralize tooth surface, periodontal debridement to reduce pocketing
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- Praxis Flashcards: Dental public health Fichas sobre Dental public health VII (100 Flash cards), creado por ACAPUN INSTITUTE el 06/08/2021.
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- ACAPUN INSTITUTE · ago 2021
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