Oral Health Health Article

PREVENTION

Prevention of dental disease may occur at the individual or community level. Prevention of disease at the community or population level is one of the foundations of public health practice. There are three levels of prevention. Primary prevention is aimed at preventing a disease before it occurs, through programs such as community water fluoridation, school dental sealant programs, and health education. Secondary prevention keeps an existing disease from becoming worse, and includes dental screenings for children and early detection of oral cancer in adults. Tertiary prevention consists of treatment to limit a disability or to help rehabilitate an individual after a disease has progressed beyond the secondary level. Examples of tertiary prevention include complex dental fillings, root canal treatment, and false teeth.

HEALTHY PEOPLE 2010

The United States has developed national health objectives with a focus on prevention. These objectives are renewed every ten years. This effort began with the 1979 report from the Surgeon General, Healthy People, and is spearheaded by the Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services. The purpose of these national health objectives is to provide direction for the country in preventing major health problems in the United States. Each set of national health objectives, including the Healthy People 2010 objectives, contain components on oral health (see Table 1).

PUBLIC HEALTH DENTISTS

Of the nine recognized dental specialties, only dental public health has the potential to make a population-based impact on communities such as schools, neighborhoods, cities, states, or nations or on groups of individuals such as homeless children or persons with HIV. Dental public health is "the science and art of preventing and controlling dental disease and promoting dental health through organized community efforts. It is the form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis" (Journal of Public Health Dentistry, 46 no. 1). Most states in the United States have a dentist trained in public health in their state health department. The same is true in some major cities. The U.S. Department of Health and Human Services also has dentists trained in public health who work in administrative and policy-making roles.

A public health dentist is primarily involved with the three core functions of public health as defined by the Institute of Medicine: assessment, policy development, and assurance. Dental public health assessment might involve a statewide survey to determine the amount of tooth decay by age group, or a questionnaire to determine the barriers to dental care for the low-income elderly. Policy development could involve efforts to have preventive services included in a dental Medicaid program or to have a state dental practice act allow dental hygienists to work under general supervision in public schools. The assurance function might take the form of a program to provide dental care to homeless children, or to provide some other service that no one else is providing.

As of 2000, only 136 dentists out of 150,000 practicing dentists were board certified in dental public health by the American Board of Dental Public Health, and only about 1,500 dentists were working primarily in this field. Although the number of public health dentists is small, they are trained to work with a variety of health professionals and community groups to improve oral health. This would include, but not be limited to, public health dental hygienists, health educators, epidemiologists, nutritionists, nurses, academicians, researchers, and other health and human services personnel.

There are ten major areas of competencies that a dentist must attain to become board certified in dental public health. These ten competencies are: program planning; population-based prevention; developing, managing, and evaluating programs; needs assessment; communication; advocacy; study design; and critiquing the literature. Public health dentists can be contacted through the oral health program of local or state health departments, or through one of the ten regional offices of the U.S. Department of Health and Human Services.