Test 3 study guide (ch. 12, 13, 14, 15)

Assessment facilities (3):

-Space -Equipment -Dental and educational materials for the program

Characteristics of a good dental index are (5):

-clarity- easy directions -simplicity- easy to use -objectivity-not subject to individual interpretation -reliability- reproducible, consistent results and calibration no matter who does the index -quantifiable- statistics can be implies

List the 3 components of evidence-based practice:

1. Research 2. Practice 3. Patient preferences

Why does evidence based research matter? But natural and disease can determine outcomes as well (3):

Agent-biological/mechanical cause of disease= bacteria or brushing hard Host-genetic or social factor contributing to person's susceptibility or resistance= tooth morph, salivary flow, personal behaviors Environment-circumstances required for disease to thrive= physical, social,economic or high sugar diet, xerostomia etc.

Steps of Program Planning (6): -Assess via surveys, existing data or dental screening -Populations dental needs -Population demographics -Facility availability and state -Workforce needed and available -Existing resources -Funding needed

Assessment

___________________ of the population- done by using surveys and / or dental screenings -Age, socioeconomic status, education/ knowledge level, cultural diversity, dental needs, demands, perceived needs, and existing problems and issues -What is the need for the population, facility needs ( nursing homes, public schools etc.) and resources

Assessment

Steps of Program Planning (6):

Assessment Dental Hygiene Diagnosis Planning Implementation Evaluation Documentation

the ability to govern one's profession and respect for others

Autonomy

Methods used to evaluate effectiveness of program continued - CLINICAL METHODS: _____________________ Tongue blade, dental mirror, flashlight

Basic Screenings

remove existing harm; promote well-being

Beneficence

the role of ethics in health care, establishes standards between morally acceptable and unacceptable research practices

Bioethics

Qualitative and Quantitative evaluation: __________ are equally important when evaluating a program

Both

Dental Indices- Dental Caries: assesses caries by a risk management assessment- identify risk factors for each pt.

CAMBRA

Methods used to evaluate effectiveness of program continued: __________________ **Important to refer if disease is identified-our responsibility, example=why we send sheet home w/ kids after school screening

Clinical Methods

Dental indices- Gingivitis: Periodontal Diseases - irreversible: classifies periodontal treatment needs quickly, uses a special probe; probe each sextant to and record deepest pocket in each

Community Periodontal Index of Treatment Needs (CPITN)

Factors to consider when developing a program: ____________________ Frequency? Is there a way to measurably evaluated the effectivene

Consistency of Program

Factors to consider when developing a program: ____________________ May not value preventive medicine or dentistry language barriers

Cultural Influences

measures all past and present evidence of a condition

Cumulative Index

Natural conclusion to the assessment phase: ___________________________________ is based on assessment Identifies needs that can be fulfilled through dental hygiene care Will address needs that will be prioritized according to importance Based upon the diagnosis, goals and objectives will then be formed Example of diagnosis based on assessment: A dental index collected on prison inmates showed moderate to advanced periodontal disease and heavy calculus. hen analyzing the information, the dental public health planner noted the majority of inmates had not had prophylaxis for 15 +years Diagnosis was then made of periodontal disease associated with no regular dental hygiene care

DH diagnosis

Dental Indices- Dental Caries: measures past and present caries hx in permanent teeth-- IRREVERSIBLE

DMFT

Know the purpose of program evaluation: ________________ is required for reporting purposes

DOCUMENTATION

Dental indices- Gingivitis: Fluorosis Index: mouth examined for enamel mottling, rate level of fluorosis in a population-normal to severe

Dean's Index of Fluorosis

standardized quantitative measurement used to analyze oral conditions in individuals and groups -During the planning stage, the index to be used is identified to be used during the implementation phase -Index used to educate, motivate and evaluate a patient -This is a legal record of findings; record and evaluate from last visit to see if your pt is motivated -Use your dental indices scores as part of home care instruction

Dental Index

Steps of Program Planning (6): -Prioritize needs -Diagnose to provide goals and objectives for blueprints

Dental hygiene Diagnosis

Dental indices- Gingivitis: Fluorosis Index: scores opacities no matter the origin; mouth examined for enamel mottling, rate level of fluorosis in a population-normal to severe;select 2 worst teeth to score

Developmental Defects of Dental Enamel (DDE)

Recorded all collected data and assessments Important for documentation to be accurate and give as much detail as possible.

Documentation

Steps of Program Planning (6): -Document all data and information throughout all stages

Documentation

Know the purpose of program evaluation: ______________ IS A KEY ELEMENT of community oral health program Again very similar to lesson planning-will the program we are planning here address the needs of our target group?

EVALUATION

Dental indices- Gingivitis: Gingivitis and Gingival changes: using wooden interdental cleaner, presence or absence of bleeding

Eastman Interdental Bleeding Index (EIBI)

Methods used to evaluate effectiveness of program continued - CLINICAL METHODS: _____________________ -Detailed visual-tactile assessment of the oral cavity with dental instruments, dental mirror, and dental light -Dental caries exam

Epidemiological examinations

Measure to determine success in meeting goals via surveys and dental indexes Make qualitative and quantitative evaluation Make ongoing revisions as needed In dental public health program evaluation is used in ALL phases of program planning; mandatory for any DH program

Evaluation

Steps of Program Planning (6): -Measure to determine success in meeting goals via surveys and dental indexes -Make qualitative and quantitative evaluation -Make ongoing revisions as needed

Evaluation

___________________ - practice of dental hygiene based on independent research done by other practitioners/ practice and scientists as reported in peer-reviewed medical and dental hygiene journals. takes into consideration the pt preferences. example: taught that all plaque had to be removed from the surface of the tooth b4 application of fluoride. Argument was the biofilm had to be removed for fluoride to be effective.After studies were conducted, it was found that the presence of plaque does not interfere w/ penetration of fluoride into the tooth structure.

Evidence based research

ongoing evaluation of the program to assess process, usually happens while planning the program

Formative Evaluation

Dental indices- Gingivitis: Gingivitis and Gingival changes: using floss only, presence or absence of bleeding only

Gingival Bleeding Index (GBI)

Dental indices- Gingivitis: Gingivitis and Gingival changes: using probe, based on the severity of inflammation at the gingival margin, determines prevalence, severity of gingivitis; score is mild, mod, or severe-REVERSIBLE

Gingival index (GI)

Ethical Issues: provides data privacy and security provisions for safeguarding medical information. Goal= protect individual's health info while allowing the flow of health info needed to provide and promote quality of healthcare and protect the public's health and well being

HIPPA -Health Information Portability and Accountability Act

Steps of Program Planning (6): -Begin program operation -Revise and make changes identified -Identify workforce and operation management

Implementation

Begin program operation Revise as necessary and adjust accordingly Includes managing the programs and the people working in it. Effective _______________ a must!

Implementation communication

Ethical Issues: Requires that a subject in a research study be educated about the study's purpose, duration, experimental procedures, alternatives, risks, and benefits. It is a process not just a form. Information is presented to the potential subjects. The information must be written in a language that the participants understand. -If the participant is non-English speaking, a minor, or not competent to give consent, informed consent becomes an extremely important ethical component of the research. -Research subjects must not be identified. Exception: if consent is obtained to use photographs in an article It should also be revised when necessary.

Informed Consent

Charged with reviewing the ethical implications of EVERY research study Two main responsibilities 1. Ensure the rights and safety of the research subjects are respected and protected 2. Must protect the institution and researchers against lawsuits and help to ensure that the research results will not be

Institutional Review Board (IRB)

measures conditions that won't change-dental caries

Irreversible Index

provide patients what is owed or deserved; promoting fairness

Justice

Factors to consider when developing a program: ____________________ Rural, suburban, or urban? In what way would this affect care? urban areas have public transportation=decrease barriers of getting to a clinic, program, etc versus someone in rural location

Location of Target Population Community

Ethical Issues: Includes plagiarism, copyright or patent infringement, falsifying or fabricating data, misrepresenting data, and conflict of interest Human subjects must ALWAYS BE VOLUNTARY; must be free to participate or not & to withdraw at anytime for any reason

Misconduct

trial and error tx practices, unreliable reports of successful perio tx, and selection of oral care products bc of advertising= as seen on tv and pts think the product must be the best!

Non-Evidence Based

Methods used to evaluate effectiveness of program continued: _____________________ -Face-to-face personal interviews -Telephone interviews -Surverys -Document analysis -Focus groups -Observation

Nonclinical methods

to do no harm, do not intentionally inflict harm

Nonmaleficence

Dental indices- Oral Hygiene: Plaque and Calculus: assess debris & calculus on tooth numbers 3F, 8F, 14F, 19L, 24L, 30 L using disclosing agent .Add scores-REVERSIBLE (what we use in clinic)

Oral Hygiene Index (OHI)

doing what provider thinks is right for the patient

Paternalism

Dental indices- Gingivitis: Periodontal Diseases - irreversible: Measures prevalence and severity of periodontal disease. Measures REVERSIBLE (gingival) and IRREVERSIBLE (attachment loss) aspects of periodontal disease of individual or group

Periodontal Disease Index (PDI)

Dental indices- Gingivitis: Periodontal Diseases - irreversible: measures periodontal disease based on exam alone or in combination with radiographs-IRREVERSIBLE

Periodontal Index (PI)

Dental indices- Gingivitis: Periodontal Diseases - irreversible: assess state of periodontal health in a rapid manner, preliminary screening to determine if full mouth probing required. Uses special probe.

Periodontal Screening and Recording (PSR)

Target population is now assessed Develop blueprint-basis for formulating how the program should run Identifying the goals, objectives and methods to measure ________________________ -A programs' effectiveness can be measured quantitatively & qualitatively Activities planned Address challenges and possible alternatives Who will fund?

Planning effectiveness/goals

Steps of Program Planning (6): -Develop blueprint -Identify methods to measure goals -Address constraints and possible alternatives

Planning- would be tx plan in clinical setting(tx plan = individual; plan=population)

Dental indices- Oral Hygiene: Plaque and Calculus: records the presence of plaque on individual tooth surfaces; uses disclosing solution- REVERSIBLE

Plaque Control Score (PCP)

Dental indices- Oral Hygiene: Plaque and Calculus: assess individual's ability to remove plaque after tb instruction-REVERSIBLE -Assess plaque debris on max facial incisors and molars and lingual mand molars 3, 8, 14, 19, 24, 30... use disclosing agent

Plaque Hygiene Performance (PHP)

Dental indices- Oral Hygiene: Plaque and Calculus: assess thickness of plaque in gingival area in evaluating each of the tooth surfaces; use a probe to identify plaque level- REVERSIBLE

Plaque Index (PI)

Dental indices- Oral Hygiene: Plaque and Calculus: determines the location, number and surfaces WITHOUT PLAQUE after using disclosing agent- REVERSIBLE

Plaque- Free Score

Similarities between private practice and research: __________________ Identifies chief complaint Takes health history Makes diagnosis Determines treatment plan Obtains informed consent for treatment Initiates treatment intervention Recalls or Reevaluates Patient

Private Practice Methodology

Law states that identifying personal information must be protected/removed when conducting research. Examples: Name Social security # Birthdate Address Phone number

Protection Health Information (PHI)

non-numerical data and answers the question, "How well did we do?

Qualitative Evaluation -Quality -Perceptions and attitudes of population

measures are reported numerically as a quantity or amount and answers the question, "How much did we do?"

Quantitative Evaluation -Quantity -Ratios, counts, proportions, rates and prevalence

_____________________should be first and foremost, to improve public health!!

Research

Similarities between private practice and research: __________________ Takes survey or makes observations about a population Conducts literature review Develops research questions or hypothesis Writes research proposals Obtains informed consent, Obtains research funding Conducts research Analyzes and publishes research results

Research Methodology

measures conditions that can change-presence of plaque

Reversible Index

Dental Indices- Dental Caries: assess the severity of root caries; only evaluate areas of root exposure-IRREVERSIBLE

Root Caries Index

method that uses observation , reason, and experimentation to gather evidence that is observed and measurable.

Scientific Method

measures presence or absence of disease

Simple Index

Dental indices- Gingivitis: Gingivitis and Gingival changes: using probe, measured on probing; score 0-5 is healthy-REVERSIBLE

Sulcus Bleeding Index( SBI)

examination of the outcomes based after put into action-HOW DID WE DO???

Summative Evaluation

when scientific discoveries are translated into everyday practice EX: study that chewing sugarless gum increases salivary flow and helps reduce formation of plaque; Dh can tell pt and can put into use! Imp for all disciplines to have scientific basis, work interprofessionally (med, dental, pth, social work etc)

Translational Research

being honest, tell the truth; having integrity

Veracity

Dental Indices- Dental Caries: "e "is for extracted teeth- measures caries in primary teeth- lowercase and is IRREVERSIBLE

deft

Assessing __________________: -Is there enough funding to start the program? -Where will the money come from? +Grants +Private monies +Donations

funding

Know the purpose of program evaluation: To know ___________________________ by using scientific techniques

how well the program worked

Assessing ______________________: -Are there enough dental professionals to complete the job? -What are the practice acts and can dental hygienists work without supervision?

personnel (manpower)

Know the purpose of program evaluation: Starts during the program _____________ phase and takes place in ________ stage!! Evaluation focuses on assessing and determining the health needs of a target population Also focuses on the content of the program to make sure it will address the needs of the target population ________________ to evaluate program effectiveness Identifies strengths and weaknesses of programs

planning every Scientific method

Common types on indices: with upper and lower numbers to measure (6):

plaque/ calculus Dental caries Gingival bleeding and gingival changes Perio disease Malocclusion Fluorosis

Best evidence, clinical experience and patient preference= where they all come together is the key Steps of the _______________________: 1) Name the problem or question 2) Form an educated guess (hypothesis) of the cause of the problem and make predictions 3) Test hypothesis by performing an experiment or study 4) Check and interpret results 5) Report results to the scientific community

scientific method

Why does evidence based research matter?

to establish a scientifically based standard of care for how we practice. This helps us make informed decisions about products and recommendations to pts.