PUBLIC HEALTH

Public Health Dentistry and Private Health Dentistry

DONE BY:
Seba Saqer
20180482

SUPMITTED FOR:
Dr Emad El Majdalawi

7 MAY 2020
❖ Comparison between the private dental practice
and public health dentistry?

1. Public Health Dentistry:

It is an area of dentistry concerned with the evaluation of dental health

needs and how the practice of dental healthcare meets those needs.
It is the science and the art of preventing and controlling disease and
promoting dental health.

Dental public health has been recognized as a specialty by the American

Dental Association since 1950 and is considered a unique, non-clinical
discipline focused on improving dental and oral health across populations
rather than among individuals. Specialists in this area mainly work for
primary care trusts and health authorities, although some take up
academic posts in the Department of Health or universities.
There is British Dental Association (BDA) launched a document in
support of the Department of Health’s White Paper Healthy Lives, Healthy
People's.

The government’s Healthy Lives, Healthy People strategy claims to mark

“a new era for public health, with a higher priority and dedicated
resources… helping people to live longer, healthier and more fulfilling
lives and improving the health of the poorest, fastest.” To meet these
challenges, dental public health members of the BDA have identified
several areas of the public health workforce that require development as
part of their commitment to improving oral health across the nation.

➢ Vision:
Healthy people in healthy communities.

➢ Mission:
Promote Physical and Mental Health and Prevent Disease, Injury, and
Disability.

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 ➢ Objectives Prevents epidemics and the spread of disease:
Protects against environmental hazards Prevents injuries Promotes and
encourages healthy behaviors Responds to disasters and assists
communities in recovery Assures the quality and accessibility of health
services.

➢ Nature of the Work:

The job of a public health dentist focuses more on office work than it does
on treatment or work in a dental clinic. The majority of the job will involve
gathering data and information and using it to spot trends or problem
areas in the field of public health The next step will be developing
programs and policy ideas that can be used to improve the public health,
In short, it's a job that involves a good to clerical office work. Public health
dentist usually find employment in the government sector, working for
government.

➢ Components of the Dental Public Health:

In the broadest sense, primary components of the dental public health

infrastructure include, but are not limited to:

• Government: State and local health departments .

• Education: Traditionally, academia involved in oral health includes
schools of Dentistry, Dental Hygiene.
• Schools of Medicine, Nursing, and other allied Health Sciences.
• preschool programs: such as Head Start, primary and secondary
schools, trade schools, vocational educational programs, dental
residencies, and dental public health fellowships.
• Workforce: Dentists, dental hygienists, dental assistants, all
members of the dental, and many traditional
• Non-dental providers: physicians, nurse practitioners, physician
assistants, midwives, pharmacists, nurses, home health aides,
water plant operators, teachers, parents, school administrators,
health boards, community health workers, and promoters
(culturally competent or ethnically affiliated liaisons that bridge the
gap within health care for the underserved).
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 ➢ Characteristics:

As would be expected, it's important for one to have specific skill set
and unique characteristics that can help improve their abilities to perform
the job. A good education and proper training will be mental and
professional experience will help as well, but the following traits can have
a big Impact on success as a public health dentist as well

Good Analytical Skills - A key part of the job is gathering data and
performing studies in order to determine which aspects of public dental
health are in need of improvement, and how to improve them. As such,
strong analytical skills are a must.
Excellent Communication - Discussing policies with lawmakers or others
in the public health field is one major part of the job, as is explaining
dental health initiatives to the public
Written and spoken communication skills are a must for the public health
dentist.

Attention to Detail - Small things can have a big impact on the overall
dental health of the public and as such it's important that a public health
dentist has good attention to detail.

➢ Community dental practice:

• Survey of the community oral health status and their demographic

characters.
• Analysis of the survey data to determine health needs.
• Program plan based on the resources available and priorities
• Financing takes place.
• Evaluation of the program progress.

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 2. Private Dental Practice:
Dentistry it is a career that provides plenty of rewards and challenges
as well as an opportunity to help people and make communities
healthier places.
Dentists work with patients and the general public to prevent and treat
dental and oral disease, correcting dental irregularities (particularly in
children) and treating dental and facial injuries.

➢ The tasks are for private dental practice:

• Assessment of dental, medical history and oral health status
• Diagnosis of the patient oral health
• Treatment plan based on diagnosis and patient needs and
priorities
• Payment method is determined
• Evaluation during treatment at specific interval.

➢ Private care services may include:

Skilled nursing or rehabilitation care Management of chronic conditions
(monitoring medications, vital signs, and changes in health) Assistance
with grooming dressing. oral hygiene, and continence Light housekeeping
(including grocery shopping and errands and laundry) Meal preparation
and assistance with feeding Companionship Respite services for family
caregivers Appointment companions and assistance getting home after
hospital or out-patient discharge Care management and coordination
services to give long-distance caregivers peace of mind or to mediate
conflicts and disagreements about a parent's or loved ones ca Assistance
caring for a family member with cognitive impairment or a physical or
injury.

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 ➢ Benefits of Private Dentistry:

So, what are the attractions of seeing a private dentist?

• Range of Services: A private dentist tends to have a much broader

range of options.
• Preventative Care: The emphasis in private dentistry is to not only
fix current problems, but also consider the patient’s long-term oral
health.
• Quality Materials: Private dentists generally have access to a
greater range of materials.
• Latest Equipment: A private practice is more inclined to invest in
the latest dental technology for diagnostics and treatment
• Availability: while NHS dentists are now scarce, with some patients
having to travel miles to find one with space, it is far easier to find
a private dentist
• Speed: A key advantage of private dentists is that they tend to be
more readily available and tend to offer a service with shorter
waiting times
• Flexibility: While NHS provision tends to be 9-5pm, private
practices often offer a wider range with early morning, lunchtime,
evening or weekend appointments
• Choice: Private surgeries often have a team of GPs and a choice as
to who you see. Excellent for those that might, for personal
reasons, prefer a female doctor or one who knows their history or
whom they feel empathy with
• Quality Time: Private dental care services allow for longer
appointment times, so that the dentist can fully assess oral and
dental health and provide preventative care/advice alongside any
restoration required
• Aesthetics: those interested in cosmetic treatments such as
whitening, implants or invisible braces will need to find a private
practice, as these are simply not available in the NHS

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 ➢ Outcomes of private dental practice:
Types of outcome measures
• Primary outcomes:
We will consider the effectiveness of different record systems or different
components in similar records systems on any objective measures of
provider performance or patient outcomes.
We will explore whether the outcomes can be considered in any of the
following broad categories:
1) Quality of dental care and the management of dental health
services e.g. evaluating the timeliness and completeness of
restorative care following root canal therapy (Shelley 2007)
2) Patient relevant outcomes e.g. patient satisfaction or clinical
outcomes like DMFT. In some interventions like patient held record
systems that aim to improve the involvement in their care process,
we would also expect outcomes like scales that evaluate patients'
perception of level of control over decision making during the
consultation will be also used.
3) Improving communication and data exchange between dental
settings and other related settings e.g. some practices might use
joint medical and dental records to ensure that both the dentists
and physician are adequately aware of the important health
problem of their patients.
Outcomes on improving communication and data exchange
include a) improving data exchange between different dental
practices or departments in dental school or dental hospital, b)
improving data exchange between the dental and medical
department and c) improving data exchange between the dental
practice and dental and medical laboratories.
4) Financial and scheduling outcomes e.g. number of bill complaints
or rebills.
We will not include studies that only evaluate the effectiveness of
the program on subjective measures of provider performance as
they are subject to bias unless explicit robust and validated
measures are used (Adams 1999).

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 • Secondary outcomes:
Process outcomes of the work of the software like quality of data,
availability of data, accessibility to data, ease of production of data,
presentation of data and handling data.

Characteristic Private dental Public health dentistry

practice
Target Individual patient Community or group of
individuals
Collection of History taking and oral Analysis of available health and
information clinical examination morbidity records
Special investigation Radiography, Epidemiological surveys
Blood test,
Biopsies,
Exfoliative cytology
Conclusions Diagnosis Situational analysis of oral
health status and need and
utilization of services
Remedial measures Treatment plan based Action plan based on demands,
on diagnosis, patient available resources and
attitude and priorities
affordability
Major emphasis Curative and Promotive and preventive care
restorative care
Requirement for Patients consent and Community participation
successes co-operation
Service provider Dentist alone, Health team professionals and
sometimes with an para professionals, community
assistant volunteers
intervention Appropriate dental Promotive and preventive
procedure measure at individual and
community level
Supportive disciplines Phycology Sociology,
Social psychology,
Education,
Epidemiology and biostatistics
Organization and Not relevant Not relevant
management
Perspective Immediate Long term
Evaluations and result Relief of symptoms Formal program evaluation
and restoration of
function
Aftercare Recall, further sitting Continuing care, self-care
funding Generally, by patient Generally, by government or
local authorities

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 References

• Healthline Editorial, Health Awareness Calendar,

Reviewed at Jan 1 2020, Available in

https://www.healthline.com/health/directory-awareness-months

• Sally Robertson, What is Dental Public Health,

Reviewed in Jan 28 2019, Available in

https://www.news-medical.net/health/What-is-Dental-Public-
Health.aspx?fbclid=IwAR0xCnTDqjiH8PA1ci-
X6EsfHF3SpJ4inAxbiIiB5XvKQd0mLVhVbS9GTgs

• Vivien Williams, A Public Health Crisis, Reviewed at

March 17 2016, Available in

https://newsnetwork.mayoclinic.org/discussion/opioid-use-a-
public-health-crisis/

• American Dental Association, Dental Public Health,

Reviewed in 2012, Available in

https://www.ada.org/~/media/ADA/Member%20Center/FIles/dp
h_educational_module.pdf

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❖With the emergence of the current global pandemic (Covid-
19), A- What is the role of public health dentistry, and what
are the challenges that it is facing it?

➢ The roles of Dental Public Health in Covid-19:

The coronavirus COVID-19 pandemic is the defining global health crisis

of our time and the greatest challenge we have faced since World War 2.
Since its emergence in Asia late last year, the virus has spread to every
continent except Antarctica. Cases are rising daily in Africa the Americas,
and Europe.

The pandemic is moving like a wave—one that may yet crash on those
least able to cope. But COVID-19 is much more than a health crisis. By
stressing every one of the countries it touches, it has the potential to
create devastating social, economic and political crises that will leave
deep scars.

On January 8, 2020, a novel coronavirus was officially announced as the

causative pathogen of COVID-19 by the Chinese Center for Disease
Control and Prevention (Li et al. 2020). The epidemics of coronavirus
disease 2019 (COVID-19) started from Wuhan, China, last December and
have become a major challenging public health problem for not only
China but also countries around the world (Phelan et al. 2020). On
January 30, 2020, the World Health Organization (WHO) announced that
this outbreak had constituted a public health emergency of international
concern (Mahase 2020).

The novel coronavirus was initially named 2019-nCoV and officially as

severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of
February 26, COVID-19 has been recognized in 34 countries, with a total
of 80,239 laboratory-confirmed cases and 2,700 deaths (WHO 2020b).

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 Due to the characteristics of dental settings, the risk of cross infection
may be high between dental practitioners and patients. For dental
practices and hospitals in countries/regions that are (potentially)
affected with COVID-19, strict and effective infection control protocols
are urgently needed. This article, based on our experience and relevant
guidelines and research, introduces the essential knowledge about
COVID-19 and nosocomial infection in dental settings and provides
recommended management protocols for dental practitioners and
students in (potentially) affected areas.

A novel coronavirus (COVID-19) is associated with human-to-human

transmission. The COVID-19 was recently identified in saliva of infected
patients. In this point-of-view article, we discuss the potential of
transmission via the saliva of this virus. The COVID-19 transmission via
contact with droplets and aerosols generated during dental clinical
procedures is expected. There is a need to increase investigations to the
detection of COVID-19 in oral fluids and its impact on the transmission of
this virus, which is crucial to improve effective strategies for prevention,
especially for dentists and healthcare professionals that perform
aerosol-generating procedures. Saliva can have a pivotal role in the
human-to-human transmission, and non-invasive salivary diagnostics
may provide a convenient and cost-effective point-of-care platform for
the fast and early detection of COVID-19 infection.

During the initial phase of a pandemic, when a vaccine is not available,

personal protective equipment (PPE) 1 plays a major part in disease
control. Dental and oral surgery procedures using drills or ultrasonic
devices cause aerosol release, and routine dentistry has therefore been
suspended in several countries, including the UK, to reduce virus
transmission. There is an urgent need for organized emergency dental
care delivered by teams provided with appropriate PPE. 2 This also
allows for redistribution of PPE to urgent care when there is inevitably
an initial shortage and distribution challenge.

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 ➢ Avoiding where possible standard infection control
precautions:
All urgent dental care centers will follow standard infection control
precautions necessary to reduce the risk of transmission of infectious
agents from both that should be used by all staff, in all settings, always,
for all patients.
• Transmission-based precautions:
In addition to SICPs, transmission-based precautions (TBPs) are applied
when SICPs alone are insufficient to prevent cross-transmission of an
infectious agent.
TBPs are additional infection control precautions required when caring
for a patient with a known or suspected infectious agent and are
classified based on routes of transmission:
• Contact precautions:
used to prevent and control infection transmission via direct contact or
indirectly from the immediate care environment. This is the most
common route of infection transmission.
• Droplet precautions:
used to prevent and control infection transmission over short distances
via droplets (>5μm) from the patient to a mucosal surface or the
conjunctivae of a dental team member.
A distance of approximately 1 meter around the infected individual is
the area of risk for droplet transmission which is why dental teams
routinely wear surgical masks and eye protection for treating patients.
• Airborne precautions:
used to prevent and control infection transmission via aerosols (≤5μm)
from the respiratory tract of the patient directly onto a Guidance for
infection prevention and control in urgent dental care setting mucosal
surface or conjunctivae of one of the dental team without necessarily
having close contact.
Interrupting transmission of COVID-19 requires contact, droplet and
aerosol precautions, depending on the procedures undertaken.

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 ➢ Infection Control in Dental Settings:

Dental patients who cough, sneeze, or receive dental treatment

including the use of a high-speed handpiece or ultrasonic instruments
make their secretions, saliva, or blood aerosolize to the surroundings.
Dental apparatus could be contaminated with various pathogenic
microorganisms after use or become exposed to a contaminated clinic
environment. Thereafter, infections can occur through the puncture of
sharp instruments or direct contact between mucous membranes and
contaminated hands (Kohn et al. 2003).
Due to the unique characteristics of dental procedures where a large
number of droplets and aerosols could be generated, the standard
protective measures in daily clinical work are not effective enough to
prevent the spread of COVID-19, especially when patients are in the
incubation period, are unaware they are infected, or choose to conceal
their infection.

• Patient placement/assessment for infection risk:

Patients must be triaged/assessed for infection risk to ensure they are
directed to the correct urgent dental care site for treatment.
Whenever possible, patients should be treated with advice, analgesia and
antimicrobials where appropriate.

• Clinical settings and care requirements:

Waiting rooms and reception areas should allow for 2-meter separation.
The care environment should be kept clean and clutter free All non-
essential items including toys, books and magazines should be removed
from reception and waiting areas.

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❖B) Summarized newly published research paper
that connects between public health dentistry
and COVID_19?

➢ According To research by Hanthel Saud newspaper:

China is currently living in a turmoil similar to the world "Resident

Eiffel". A deadly and dangerous virus has spread in it, which has
prevented travel to some cities until it has closed entire cities and
banned their citizens from leaving the house, the virus is in great
expansion and the chances of it could be an epidemic, and doubts
about the reasons for its spread.

Everything was fine in China. the itineraries are crowded, the markets
are full, and there is nothing to worry about, but from the beginning of
the month of 12 of 2019, some workers working in an animal and
seafood store suffered from "pneumonia" but when they visited the
doctor How much determines the type of inflammation and tells them
that it is unknown?
After these cases, they got that more than 100 cases suffered from this
mysterious inflammation in the same period, and they were all from
the city of Unity in central China called "Wuhan". This raised
suspicions, but they expected that it was just an ordinary episode, until
it came on December 31 / 2019 The doctor visited a very critical
condition suffering from this inflammation
They estimated that the doctors extracted samples from the case and
discovered that the infection was from a virus that is 70% similar to the
sequence of the Corona virus. The strange thing is that there are only
six types of Corona virus that can infect humans, and this is a new type
of them that means a seventh type!
The new type of corona virus was named (nCoV-2019).

There is no vaccine for the virus, but the methods of prevention are:
Wash hand frequently and cleanser, such as soap
Do not touch your nose, mouth, or eyes if your hand is dirty
Try to avoid direct contact with infected people or share tools

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 ➢ The research recommends:

• Should not wear medical masks as this may cause unnecessary cost,
procurement burden and create a false sense of security that can
lead to neglecting other essential measures such as: hand hygiene
practices. Furthermore, using a mask incorrectly may hamper its
effectiveness to reduce the risk of transmission.
• Masks might be worn in some countries according to local cultural
habits. They do, however, recommend that individuals with
respiratory symptoms should wear a medical mask and seek medical
care if experiencing fever, cough and difficulty breathing, as soon as
possible.
• Research has shown that when a mask was used on the source, it
achieved far greater levels of protection than when used by the
receiver.
• Health care workers should wear a medical mask when entering a
room where patients suspected or confirmed of being infected with
COVID-19 are admitted and in any situation of care provided to a
suspected or confirmed case.
• The CDC states that, when available, respirators (instead of face
masks) are preferred; they should be prioritized for situations where
respiratory protection is most important and for the care of patients
with pathogens requiring airborne precautions (for example,
tuberculosis, measles, and varicella).
The Health and Safety Executive back in 2008 evaluated the protection
afforded by different types of masks against influenza bio aerosols and
recommended the wearing of class FFP3 disposable respirators when
carrying out clinical procedures likely to generate aerosols of respiratory
secretions from infected patients, such as dental drilling. They noted
that it is a common misperception that regular surgical masks will
provide protection against aerosols and recognized the challenges of
widespread delivery of FFP3 during a pandemic.

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 ➢ Discussion:

In my opinion, the dental team are familiar with assessing cross-

infection risk but should not be placed at unnecessary risk themselves as
this would be morally unacceptable. I personally became increasingly
concerned that asymptomatic patients might well be infectious, and that
dentists and oral surgeons were not using protection with gowns, gloves,
FFP3 masks and eye protection because of lack of availability. I decided
that I needed to act rather than wait for more evidence. As Dean and
Director of a dental school, I decided to suspend all patient care by
undergraduate and postgraduate students on 16 March 2020. Non-
clinical teaching, as elsewhere at other universities, was rapidly being
moved to online platforms. I had set up a small COVID-19 planning team
of senior staff some time earlier who worked tirelessly to manage the
fallout. Students were obviously anxious and the impact on the NHS
Partner Trust was significant. My measures were contrary to the then
NHS advice and so my justification was required. This was based on
growing but incomplete evidence and a moral judgement.

The theory that high viral load exposure of frontline medical staff in
China was implicated in the severity of disease suffered and deaths of
doctors and medical students was reported in the press, but not
published in the scientific literature. If this was true, then surely dentists
and other members of the team would be at risk because of the high
volume of patients seen and with close contact. I was anxious about the
risk to my oral surgery and GDP colleagues. As President of the British
Association of Oral Surgeons (BAOS), I wanted to express my concern
and so published a President's Newsletter online on 16 March 2020,
titled 'The Oral Surgery Response to Coronavirus Disease (COVID-19).
Keep Calm and Carry On?' which included my views for routine dental
care.11 This was supported by all BAOS council members and I was
grateful for that. I had wrestled with publicly expressing my views as
they were contrary to the then official NHS advice. Was I wrong? What
level of PPE was really required? Would I be responsible for economic
downturn in general dental practice that would be looked back on and
criticized for being disproportionate? I was also conscious that I was free

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to rapidly put out messages as an independent clinical academic that
many in professional leadership were hampered from doing because of
the bureaucratic systems in which they worked, requiring greater
evidence, approvals and sign-offs. In the initial phase of a pandemic
when a vaccine is not available, PPE plays a major part in control.12 It
makes sense to reduce routine care and direct appropriate PPE to urgent
dental care when there will inevitably be an initial shortage and
distribution challenge.
The BAOS went on to put out a Joint Position Statement on COVID-19
and patient care with BAOMS on 20 March 2020, whose leadership were
as keen as I to get messages out for surgeons and GDPs.13 This was
followed by specific recommendations for urgent care of patients during
the pandemic. I am comfortable that it was morally justified to get those
early messages out to start the discussion and behavior change. I am
also aware that we will look back and appreciate that the differences in
time of the various specialty and regional messages were actually not so
significant.

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 References

• COVID-19 Outbreak, An Overview on Dentistry,

Reviewed at Feb 17 2020, Available in
https://drive.google.com/file/d/1h5n5WGnv4Eet0ixfBlhbD0lBmaX1Riz8
/view?fbclid=IwAR0XK3_Il_FA96-
4km4dEXvpiOYg7pLQGNejV8qrV8f2mD9NcI9OnXauXas

• Healthline Editorial, Health Awareness Calendar,

Reviewed at Jan 1 2020, Available in
https://www.healthline.com/health/directory-awareness-months

• Sally Robertson, what is Dental Public Health,

Reviewed in Jan 28 2019, Available in
https://www.news-medical.net/health/What-is-Dental-Public-
Health.aspx?fbclid=IwAR0xCnTDqjiH8PA1ci-
X6EsfHF3SpJ4inAxbiIiB5XvKQd0mLVhVbS9GTgs

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