Discussion

Public health focuses on the prevention of disease. Three levels of disease prevention have been identified: primary, secondary, and tertiary (Mason 2010, p. 112). Primary prevention is the intervention in disease before it occurs. Examples of primary preventive interventions include community water fluoridation, fluoride varnish, pit and fissure sealants, and preventive education. Secondary prevention is the treatment or control of disease early in the process. Remineralization of early caries and periodontal debridement are examples of secondary prevention methods. Tertiary prevention involves strategies to replace lost tissues through rehabilitation to restore the functions of the oral cavity to as close to normal as possible. An example is the replacement of a missing tooth with an implant.

Preventive oral health services are essential in maintaining the dental health needs of the population. However, there are many barriers that should be considered when providing these services. Examples of major factors that prevent or deter the population from gaining access to care are the following (Darby and Walsh 2015; Nathe 2017):

1. Financial barriers – unaffordable costs, no spendable income, cannot afford time off if an hourly paying job.
2. Transportation – public transportation is often unreliable, unaffordable, nonexistent, and confusing. Homebound, hospitalized, or institutionalized clients frequently cannot be transported for care.
3. Psychological barriers – fear or inability to comprehend dental procedures, feelings of anxiety, low pain tolerance.
4. Special needs – needs to rely on others for transportation or care impact scheduling and compliance; sensory and physical impairments.
5. Geographic barriers – shortages of providers in rural areas, regional maldistribution of health‐care personnel.
6. Physical facilities – nowhere to park safely, too many stairs, narrow doors, and entryways, bathrooms without grab bars, dimly lit hallways, and small signage, and inconvenient office hours.
7. Cultural diversity/influences – based on cultural, family, and individual beliefs patients will have different orientations toward health; language barriers.

School‐based oral health programs are designed to improve access to dental care by reducing barriers. Barriers that may be reduced may include parents taking time off of work to take their child to the dentist during the day, children missing classroom time for dental visits, dealing with limited access to oral care in rural communities, and lack of reliable transportation (MCOH 2011). All children and often parents can benefit from children receiving oral health screenings in school, which is a familiar, nonthreatening environment. Services that are typically performed in this setting include dental education, oral screenings, fluoride applications, sealant placement, and referral for follow up treatment if needed (MCOH 2011). School‐based health programs can also be included in the curriculum in all grades so teachers can incorporate oral health into the classroom.

Health preventive programs are created to prevent disease in a target population (Nathe 2005, p. 171). Preventive programs may occur in a wide range of settings in addition to schools, such as communities and health‐care facilities. Dental health programs that involve dental hygienists have included oral health education programs to provide dental health tools to large populations, use of fluoride to prevent caries, dental sealants, athletic mouth guards, nutritional advising, and provision of other preventive services to large populations of need. Regardless of the preventive program designed, the program planning paradigm must be considered to be able to address the specific needs of the target population and available evidence‐based resources.

The dental hygiene program planning paradigm is similar to the dental hygiene process of care consisting of the same steps: assessment of the situation, formulation of a dental hygiene diagnosis, planning the program, putting the plan into action, and evaluation. During the evaluation stage in the program planning paradigm, the results of the program are measured against the objectives developed during planning. Evaluation is ongoing throughout the program and upon its completion. The dental provider uses scientific techniques to discern the program effectiveness. A combination of quantitative and qualitative methods should be used to measure if objectives were met (Kaur 2016). Quantitative methods are based on numbers to claim objectivity; whereas, qualitative methods generate theories relying on subjectivity (Kaur 2016, p. 94). Quantitative data is precise and qualitative data is descriptive.

To aid in assessment and evaluation by providing quantitative data, indices are used by community programs to determine and record the oral health status of groups (see Table 12.2.1). They can assess the needs of a community, assist in planning community‐based health promotion/disease prevention programs, and compare the effects or evaluate the results of community‐based programs (Wilkins et al. 2017, p. 371). Indices provide a way to express clinical observations in the use of numbers.