Diploma of the Faculty of Dental Surgery (MFDS) Dental Public Health, Prevention and Special Care Syllabus

Dental Public Health, Prevention and Special Care syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Dental Public Health, Prevention and Special Care in Diploma of the Faculty of Dental Surgery (MFDS), not a summary of it.

1. 1

   Epidemiology and Evidence-Based Dentistry

   4 topics

   • Measuring oral disease
     • DMFT, prevalence and incidence
   • Study design and levels of evidence
     • RCTs, cohort and case-control studies
   • Critical appraisal of literature
     • Bias, confounding and validity
   • Application of guidelines to practice
2. 2

   Prevention of Oral Disease

   5 topics

   • Fluoride and remineralisation
     • Toothpaste, varnish and water fluoridation
   • Dietary advice and sugar reduction
   • Fissure sealants and preventive resin restorations
   • Delivering Better Oral Health toolkit
   • Behaviour change and motivational interviewing
3. 3

   Oral Health Promotion and Inequalities

   4 topics

   • Determinants of oral health
     • Social, economic and environmental factors
   • Health promotion models and the common risk factor approach
   • Addressing health inequalities and access
   • Community-based and population-level interventions
4. 4

   Special Care Dentistry

   5 topics

   • Patients with physical and learning disabilities
     • Reasonable adjustments and the Equality Act
   • Care of older and frail patients
     • Domiciliary care and frailty
   • Capacity, consent and best interests
     • Mental Capacity Act and deprivation of liberty
   • Safeguarding vulnerable adults
   • Management of medically complex patients in primary care

Dental Public Health, Prevention and Special Care flashcards for Diploma of the Faculty of Dental Surgery (MFDS)

25 of 54 cards from the Dental Public Health, Prevention and Special Care deck — real questions with worked answers.

1. What is the DMFT index and what does each letter represent?

   DMFT is a measure of caries experience in permanent teeth: D = number of Decayed teeth, M = Missing (due to caries), F = Filled teeth. It is summed per individual (max 28 or 32) and averaged across a population. The lowercase equivalent (dmft) is used for the primary dentition.

2. How is the prevalence of a disease distinguished from its incidence?

   Prevalence = the proportion of a population that has the disease at a given point in time (existing cases). Incidence = the number of NEW cases arising in a defined population over a specified time period. Prevalence reflects burden; incidence reflects risk of developing disease.

3. What is the Significant Caries Index (SiC Index) and why was it introduced?

   The SiC Index is the mean DMFT of the one-third of the population with the highest caries scores. It was introduced by Bratthall (2000) because population mean DMFT can hide the skewed distribution of caries, which is concentrated in a high-risk minority. It highlights health inequality.

4. List the levels of evidence in a typical hierarchy of evidence, from strongest to weakest.

   From strongest to weakest: 1) Systematic reviews/meta-analyses of RCTs; 2) Individual randomised controlled trials (RCTs); 3) Cohort studies; 4) Case-control studies; 5) Cross-sectional studies; 6) Case series/case reports; 7) Expert opinion/anecdote.

5. What study design is best suited to investigating a rare disease, and why?

   A case-control study. Because it starts with people who already have the (rare) outcome and compares their past exposures with controls, it does not require following a huge cohort to accumulate enough cases. It is efficient for rare diseases and long latency conditions.

6. Define randomisation and explain its main purpose in an RCT.

   Randomisation is the allocation of participants to study groups purely by chance. Its main purpose is to balance both known and unknown confounding variables between groups, eliminating allocation/selection bias and allowing causal inference about the intervention.

7. What is the difference between the relative risk (RR) and the odds ratio (OR)?

   RR is the ratio of the probability (risk) of an outcome in the exposed group to that in the unexposed group, used in cohort/RCT designs: $RR = \frac{a/(a+b)}{c/(c+d)}$. OR is the ratio of the odds of exposure (or outcome) between groups, used in case-control studies: $OR = \frac{a \cdot d}{b \cdot c}$. OR approximates RR when the disease is rare.

8. State the formulas for sensitivity and specificity of a diagnostic test.

   $$\text{Sensitivity} = \frac{TP}{TP + FN}$$ (proportion of true cases correctly identified) and $$\text{Specificity} = \frac{TN}{TN + FP}$$ (proportion of true non-cases correctly identified), where TP = true positives, FN = false negatives, TN = true negatives, FP = false positives.

9. What does a p-value of 0.05 conventionally signify, and what is a 95% confidence interval?

   A p-value of $0.05$ means there is a 5% probability that the observed result (or more extreme) would occur by chance if the null hypothesis were true; values $\leq 0.05$ are conventionally 'statistically significant'. A 95% confidence interval is the range within which the true population value is expected to lie 95% of the time on repeated sampling; if it crosses the null value (1 for ratios, 0 for differences), the result is not significant.

10. Name the key questions/domains a critical appraisal of a research paper should address.

    Are the results valid (internal validity: study design, randomisation, blinding, follow-up, confounding)? What are the results (effect size, precision/confidence intervals, statistical significance)? Will the results help my patients (external validity/applicability, generalisability, benefit vs harm/cost)? Tools such as CASP checklists structure this.

11. What is the difference between Number Needed to Treat (NNT) and how is it calculated?

    NNT is the number of patients who must receive a treatment for one additional patient to benefit. It is the reciprocal of the absolute risk reduction (ARR): $$NNT = \frac{1}{ARR} = \frac{1}{CER - EER}$$ where CER = control event rate and EER = experimental event rate. A lower NNT indicates a more effective treatment.

12. Define a confounding variable and give an example relevant to caries research.

    A confounder is a variable independently associated with both the exposure and the outcome, distorting the apparent relationship between them. Example: socioeconomic status confounds the link between sugar consumption and caries, because deprivation is associated with both higher sugar intake and higher caries rates.

13. What is the GRADE system used for in evidence-based practice?

    GRADE (Grading of Recommendations, Assessment, Development and Evaluations) is a system for rating the certainty (quality) of a body of evidence as high, moderate, low or very low, and for grading the strength of recommendations (strong vs weak/conditional), accounting for risk of bias, inconsistency, indirectness, imprecision and publication bias.

14. How does fluoride promote remineralisation of early enamel lesions?

    Fluoride present at the enamel surface (from saliva/plaque fluid) is incorporated into the remineralising crystal, forming fluorapatite/fluorhydroxyapatite which is more acid-resistant. It favours net mineral gain by promoting precipitation of calcium and phosphate when pH rises, and it inhibits demineralisation and bacterial metabolism (enolase) at higher concentrations.

15. What is the 'critical pH' for enamel demineralisation and why does it matter?

    The critical pH for hydroxyapatite enamel is approximately $5.5$. Below this pH the surrounding fluid becomes undersaturated with respect to enamel mineral, so demineralisation occurs. Fluorapatite has a lower critical pH (~$4.5$), making fluoride-treated enamel resistant at lower pH values.

16. What concentration of fluoride toothpaste does Delivering Better Oral Health recommend for adults and high-risk children?

    Standard adults: at least 1350-1500 ppm fluoride. Children aged 0-6 use 1000+ ppm. For those giving concern/high caries risk: children aged 10+ and adults may be prescribed 2800 ppm; adults (and from age 16) at high risk may be prescribed 5000 ppm fluoride toothpaste.

17. State the 'spit, don't rinse' advice and the rationale behind it.

    After brushing, patients should spit out excess toothpaste but NOT rinse with water or mouthwash. This retains a higher concentration of fluoride in the oral fluid and on tooth surfaces, prolonging its protective remineralising effect.

18. What is the recommended frequency of fluoride varnish application for children, and what concentration is used?

    Fluoride varnish (typically 22,600 ppm F, i.e. 5% sodium fluoride / Duraphat) should be applied at least twice yearly to all children aged 3 and over, and 2-4 times yearly for those at higher caries risk. It is also recommended from age 2 for children of concern.

19. According to current dietary guidance, what is the recommended maximum intake of free sugars?

    Free sugars should account for no more than 5% of total dietary energy intake. In practical UK terms this is about 30 g/day for adults and children aged 11+, with lower limits for younger children. Reducing both the amount and frequency of free sugar intake lowers caries risk.

20. What are 'free sugars' as defined for dietary advice?

    Free sugars are all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups, and unsweetened fruit/vegetable juices and smoothies. They EXCLUDE sugars within the cellular structure of whole fruits/vegetables and lactose in milk/dairy.

21. Describe the Stephan curve and its significance for dietary advice on caries.

    The Stephan curve plots plaque pH over time after a sugar exposure: pH drops rapidly below the critical pH (~5.5) within minutes due to bacterial acid production, then gradually recovers over 30-60 minutes as saliva buffers and clears the acid. Frequent sugar intakes keep pH below critical for longer, so reducing FREQUENCY (not just amount) of intake is key preventive advice.

22. What are the main indications for placing a fissure sealant?

    Deep, retentive pits and fissures; teeth at high caries risk (e.g. caries in other teeth, medical/social risk factors); newly erupted permanent molars; non-cavitated (early/initial) occlusal caries that can be sealed over; and patients with special needs where prevention is a priority.

23. What is a preventive resin restoration (PRR) and how does it differ from a simple fissure sealant?

    A PRR (also called sealant restoration) combines a minimal composite/GIC restoration of a small area of frank occlusal caries with a fissure sealant covering the remaining sound fissures. Unlike a simple sealant (which only seals sound or non-cavitated fissures), a PRR involves removing localised carious tissue first while conserving sound tooth structure.

24. Which materials are most commonly used for fissure sealants, and when is glass ionomer preferred over resin?

    Resin-based (BIS-GMA) sealants are the gold standard, offering superior retention, but require good moisture control. Glass ionomer cement (GIC) sealants are preferred when moisture control is difficult (e.g. partially erupted teeth, uncooperative or special-needs patients) because they tolerate moisture and release fluoride, though retention is lower.

25. What are the eight evidence-based interventions/areas covered by the Delivering Better Oral Health (DBOH) toolkit?

    DBOH covers: 1) Healthier eating/diet and reducing sugar; 2) Toothbrushing with fluoride toothpaste; 3) Fluoride (varnish, higher-strength pastes, supplements); 4) Fissure sealants; 5) Smoking/tobacco cessation; 6) Alcohol reduction; 7) Periodontal/gum health and plaque control; 8) Prevention of erosion. It is the national evidence-based prevention toolkit for the dental team.

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