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Dental public health > 4 - Dental caries epidemiology : the prevalence and impact of disease > Flashcards

4 - Dental caries epidemiology : the prevalence and impact of disease Flashcards

1
Q

what is epidemiology?

A 
Epidemiological surveys aim to give an overview of disease levels in the population –
• how many people have decay? 
• how much decay do they have? 
• which groups have most decay? 
• has decay been treated?
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2
Q

What can epidemiological date be used to make?

A

comparisons, identify treatment needs and plan services or preventive activities at population level

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3
Q

what occurs in a clinical exam?

A
  • Look at an individual patient
  • Aim to diagnose all caries
  • Additional tests as required (eg. radiographs)
  • Outcomes used to treatment plan for individual patient – monitor/restore/extract teeth and offer individualised advice
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4
Q

what occurs in epidemiology?

A 
• Look at population
• Record caries at level specified
by criteria
• No special tests (usually)
• Outcomes used to identify needs of population – monitor changes over time, plan services/ preventive programmes
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5
Q

what is the stage before very early decay?

A

sub-clinical initial lesions in a dynamic rate of progression/regression

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6
Q

what are the various stages of tooth decay?

A
  • very early stage decay- small lesions detectable only with additional diagnostic aids
  • inital decay - clinically detectable enamel lesions with “intact” surfaces
  • moderate decay- clinically detectable ‘cavities’ limited to enamel
  • extensive decay - lesions into the pulp/ clinically detectable lesions in dentine
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7
Q

what stages of decay are obvious and assessed in detailed NDIP inspections?

A

-extensive decay

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8
Q

How do we measure caries in individual teeth?

A
  • sound surface
  • enamel caries , no cavitation,- D1
  • Cavity in enamel only -D2
  • clinically detectable caries into dentine - D3
  • treated : restored/ extracted
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9
Q

what is used to record dental decay in a consistent way?

A

caries index

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10
Q

what is the most commonly used caries index?

A

DMFT

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11
Q

what does the DMFT record?

A

number of decayed, missing and filled teeth

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12
Q

what does the DMFT describe?

A

describes the number of teeth with “decay experience”

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13
Q

what happen with DMFT over time?

A

cumulative over time

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14
Q

what can each teeth only be?

A

one of decayed/missing/filled

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15
Q

what is the order of precedence?

A
  • missing
  • decayed
  • filled
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16
Q

what are crowns included in?

A

“filled” teeth

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17
Q

what are the variations of DMFT?

A
  • dmft - Decayed, missing and filled DECIDUOUS teeth
  • DMFS -Decayed,missingandfilledSURFACES
  • dmfs - Decayed, missing and filled surfaces of deciduous teeth
  • def - Decayed, extracted and filled deciduous teeth
  • D3MFT - Decayed (into dentine), missing and filled teeth
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18
Q

what is clinically detectable in D3 level?

A

lesions in dentine

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19
Q

what may D3 level be?

A

may be “cavitated” or “visual;” (grey shadow)

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20
Q

why use D3?

A
  • Level at which restorative treatment indicated
  • Also described as “obvious decay”
  • More consistent recording
21
Q

what is inter-examiner reliability?

A

if more than one clinician looks at the same tooth they would record the same score

22
Q

what is intra-examiner reliability?

A

if the same clinician saw the same tooth again they would give it the same score each time

23
Q

what does DMFT equal?

A

number of teeth with caries experience

24
Q

what does DT/DMFT x 100 equal?

A

% of caries experience which is untreated = indicator of treatment need

25
Q

what does FT/DMFT x 100 equal?

A

% caries experience that has been restored = care index

26
Q

what are the limitations of DMFT?

A

• Each component has equal weight in index but unequal impact on patient
• Not ideal for mixed dentition
• M may count teeth missing for reasons other than caries
• Exfoliated, Orthodontic extractions, Unerupted, Hypoplasia, Trauma
• Fillings may have been placed for lesions which would not have been
counted as carious
• Trauma, Aesthetics, Hypoplasia
• Decay experience is irreversible – can’t use to measure effectiveness of beneficial interventions

27
Q

what does standardising survey methodology do?

A
  • Aims to increase consistency between epidemiological surveys
  • Sets out standards for the examination
  • Criteria for recording disease
  • Conventions for recording eg trauma, unerupted teeth
28
Q

what is the national dental inspection programme?

A
  • School Dental Inspection Programme
  • P1s (age 5), P7s (age 11)
  • Annual “Basic Inspection” – all P1 and P7 = risk assessment
  • 3 categories: urgent dental problem, care needed, no obvious problems
  • Alternate years sample from P1/P7 “Detailed Inspection” – dmft P1, DMFT P7
29
Q

what information is given in NDIP report?

A 
• % “No obvious decay experience”:
>% with DMFT=0
> NOT the same as % caries free
• Average number of teeth affected by decay:
>Mean DMFT
• Trends over time
• % decay treated with fillings
• % decay untreated
• Geographic comparisons (by Health Board) 
• Comparison by area deprivation
30
Q

who is affected most by caries?

A

deprived populations

31
Q

what was the distribution of caries in 2017-2018 report (P1)?

A

71% no obvious decay, mean dmft = 1.14

32
Q

what was the distribution of caries in 2016-2017 report (P7)?

A

77% no obvious decay, mean DMFT = 0.49

33
Q

why is caries a problem?

A

-Effects on individual :

pain, infection , swelling, appearance, ability to eat , mental health etc..

34
Q

what is oral health?

A

“A standard of health in the oral and related tissues without active disease. That state should enable the individual to eat, speak and socialise without discomfort or embarrassment and contribute to general wellbeing”

35
Q

what impacts all aspects of oral health?

A

caries

36
Q

Describe craies at the population level.

A

• Treatment needs – access to services
- cost (to individual and health system)
• Most common reason for child to have General Anaesthetic • School absences (+ parents time off to attend appts)
• Absence from work – cost to employer
• Reduced function – contribution to society

37
Q

what are the economics of dental caries?

A
  • Time lost from work – sick pay, reduced tax revenue :Estimated 12-15 million working days lost each year due to dental problems
  • Cost of providing dental services
38
Q

what are the dental fees in Scotland for children?

A
  • Approx £75 million

* Avge £73 per child

39
Q

what are the dental fees in Scotland for adults?

A
  • Approx £215 million

* Avge £49 per adult

40
Q

what investments have been put into prevention and oral health?

A

• Childsmile
• Priority Groups Strategy
• Oral Health Improvement
Plan, 2018

41
Q

what is a consequence if oral health is not viewed as a priority?

A

difficult to make progress

42
Q

what is an another approach to promoting oral health?

A

“Public health solutions are most effective when they are integrated with those for
other non communicable diseases and national public health programmes”

43
Q

what are non -communicable diseases?

A

not passed from person to person

44
Q

Name some non-non-communicable diseases

A
  • obesity
  • cancer
  • heart disease
  • caries
45
Q

what is used for non-communicable diseases?

A

common risk approach

46
Q

what are the benefits of the common risk factor approach?

A
  • Value for money – tackle multiple problems at same time
  • More consistent messages
  • Greater impact if multiple agencies join together
  • Encourages broader perspective than individual “victim blaming”
47
Q

What are examples of tackling common risk factors are policy level?

A
  • smoking legislation
  • minimum unit pricing
  • sugar tax
48
Q

How else can we use the common risk factor approach?

A
  • Give advice in context of other benefits as well as dental
  • Work in partnership with others tackling common risk factors
  • Link oral health with national campaigns eg. fizz free February, no smoking week, change for life
  • Make oral health part of healthy eating in schools eg. school health weeks
49
Q

What are the key points of this lecture?

A
  • DMFT quantifies caries experience in populations
  • Epidemiological studies tend to underestimate caries
  • Caries has significant impacts on individuals and populations and brings economic costs
  • Prevention of caries requires investment and policy support
  • A common risk factor approach is likely to be more effective than focussing on oral health in isolation

Dental public health (4 decks)

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