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Community Dentistry Years I - IV Dr David Locker Room 521 (ext 4490)
Year I:  Term I ,[object Object],[object Object],[object Object]
Year I:  Term II ,[object Object]
Year II:  Term I ,[object Object]
Year II:  Term II ,[object Object]
Years III and IV ,[object Object],[object Object],[object Object],[object Object]
? Years I and II Providing clinical care to patients ,[object Object],[object Object],[object Object]
Year 1: Fall Term Lecture 1
Introduction to Epidemiology ,[object Object],[object Object],OBJECTIVES:
Two Types of Health Care ,[object Object],[object Object],[object Object],Clinical Practice: ,[object Object],[object Object],[object Object],Population (Public) Health Practice:
[object Object]
EXPOSURES INTERVENTIONS OUTCOMES Causation
All decisions that health professionals make health professionals make involve assumptions about causal mechanisms
Causal Relationships in Health Care Aetiology: Risk factors Disease Therapy: Treatment Improvement in patients condition Health service Health services Improved  delivery: community health
[object Object],[object Object],[object Object],[object Object],[object Object]
SCIENTIFIC METHODS CRITICAL APPRAISAL EVIDENCE BASED CARE
Characteristics of Epidemiology ,[object Object],[object Object],[object Object]
Science A systematic set of methods for producing knowledge about events and their relationships which eliminates chance, bias and error.
Power of Epidemiology 1854 London cholera epidemic 1940 Fluoride and dental caries 1970 US toxic shock syndrome epidemic
London cholera epidemics 1848-1854
Table 1:  Results of Snow’s Investigation 61 Known to have drunk pump water 6 Believed not to have drunk pump water 6 No info 5 In families sending to Broad St. pump for water 3 Children attending school near pump 2 No info 73 living near Broad St. pump 10 not living near pump 83 Deaths* * Out of 83 individuals who had died of the disease, 69 were known definitely or could be assumed to have drunk the pump water, 6 were believed not to have drunk it, and for 8 there was no information
Fluoride and dental caries (see attachment)
Mechanisms by which fluoride considered to inhibit dental decay ,[object Object],[object Object]
Mechanisms by which fluoride considered to inhibit dental decay ,[object Object],[object Object],[object Object]
Fluoride mechanisms Better understanding of mechanisms Debate re: modes of delivery
Toxic shock syndrome
[object Object],[object Object],[object Object]
Two Approaches to Explaining and Controlling Disease Environmental: Mechanistic: ,[object Object],[object Object]
LUNG CANCER CARCINOGENESIS SMOKING
1974 1915 Oral cancer 1958 1798 Smallpox 1928 1753 Scurvy Agent Preventive measure Disease
Sequence of epidemiological reasoning Observation Suspicion Hypothesis
Epidemiological study Statistical association Causal inference Prevention
Types of Epidemiology Classical: Modern: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Current Applications of Epidemiology
What is the oral health status of Ontario’s elderly? Is there an association between smoking and the onset and course of periodontal disease? Does community water fluoridation increase the risk of hip fracture in the elderly? Does the use of dental services by adolescents decline after school dental programs cease?
How does chronic facial pain affect the quality of life?  Is this improved following consultation and treatment at a specialist pain clinic? How much variation is there in dentists’ diagnoses of caries based on radiographs? What proportion of the population avoid dental treatment because of fear and anxiety, and how is this changing over time?
? Does oral infection (periodontal disease) increase the risk of major systemic disorders such as heart disease, stroke and low birth weight?

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Community Dentistry Years I - IV

  • 1. Community Dentistry Years I - IV Dr David Locker Room 521 (ext 4490)
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  • 8. Year 1: Fall Term Lecture 1
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  • 13. All decisions that health professionals make health professionals make involve assumptions about causal mechanisms
  • 14. Causal Relationships in Health Care Aetiology: Risk factors Disease Therapy: Treatment Improvement in patients condition Health service Health services Improved delivery: community health
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  • 16. SCIENTIFIC METHODS CRITICAL APPRAISAL EVIDENCE BASED CARE
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  • 18. Science A systematic set of methods for producing knowledge about events and their relationships which eliminates chance, bias and error.
  • 19. Power of Epidemiology 1854 London cholera epidemic 1940 Fluoride and dental caries 1970 US toxic shock syndrome epidemic
  • 21. Table 1: Results of Snow’s Investigation 61 Known to have drunk pump water 6 Believed not to have drunk pump water 6 No info 5 In families sending to Broad St. pump for water 3 Children attending school near pump 2 No info 73 living near Broad St. pump 10 not living near pump 83 Deaths* * Out of 83 individuals who had died of the disease, 69 were known definitely or could be assumed to have drunk the pump water, 6 were believed not to have drunk it, and for 8 there was no information
  • 22. Fluoride and dental caries (see attachment)
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  • 25. Fluoride mechanisms Better understanding of mechanisms Debate re: modes of delivery
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  • 30. 1974 1915 Oral cancer 1958 1798 Smallpox 1928 1753 Scurvy Agent Preventive measure Disease
  • 31. Sequence of epidemiological reasoning Observation Suspicion Hypothesis
  • 32. Epidemiological study Statistical association Causal inference Prevention
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  • 35. What is the oral health status of Ontario’s elderly? Is there an association between smoking and the onset and course of periodontal disease? Does community water fluoridation increase the risk of hip fracture in the elderly? Does the use of dental services by adolescents decline after school dental programs cease?
  • 36. How does chronic facial pain affect the quality of life? Is this improved following consultation and treatment at a specialist pain clinic? How much variation is there in dentists’ diagnoses of caries based on radiographs? What proportion of the population avoid dental treatment because of fear and anxiety, and how is this changing over time?
  • 37. ? Does oral infection (periodontal disease) increase the risk of major systemic disorders such as heart disease, stroke and low birth weight?