Lecture 17: Oral Health Flashcards
What type of study is best for life cource research? why?
Prospective cohort study
- gold standard design
- representative sample
- exposure, cofounders, disease incidence, increment
you can follow over time, see as much of the life course as possible, cohort study gives dynamic measures
what are some common oral conditions?
- dental caries
- periodontitis
- tooth loss
- malocclusion
- enamel defects
- dry mouth
- oral mucosal conditions
what are the characteristics of tooth decay?
- incremental
- cumulative
- highly prevalent
what are some challenges with dental caries?
- ‘case’ status
- multiple surfaces, multiple teeth
- a range of presentations
- cumulative condition
- the same surface can be affected more than once
- any index needs to reflect the condition’s:
cumulative nature
different presentations
what are some advantages that come with the challenges of dental caries?
- these characteristics give a good measure of examining social inequalities in health throughout life
- especially if we use an indicator such as tooth loss due to caries
how are dental caries reported?
There are 2 main measures
1) Prevalence
- % with the disease
- reported in the SDS as the “% caries-free”
2) Caries experience (aka severity)
- mean DMF score (DMFT or DMFT) decay missing or filled surfaces, decay missing or filled teeth
- reported in the SDS as meant mft (age 5) or MFT (year 8)
other useful indicatord:
- prevalence of 4+ dmf (or DMF)
- gives an idea of the tail of the distribution
what are the DMF score ranges?
DMFT = 32 (max 32 teeth)
DMFS = 148 (4 anterior/posterior surfaces + 5 surfaces/posterior x 4 quadrants)
why is the dunedin study significant in oral health?
only study that follows people into adulthood
what was the inaccurate out of date measure of tooth decay?
most of this information came from cross-sectional surveys which don’t show natural history
the trend showed high rate in childhood, adolescence but at end of teenage years through adulthood tooth decay was low until we get old
- but this is more likely to be due to people opting to have all teeth out during early 20’s as routine dental care was unaffordable and unpleasant
what was the average trajectory of tooth decay in the dunedin study/
approx 1 surface per year (as people aged) was affected by tooth decay
what is this?
average data of all dunedin study members
very straight data
what is this?
individual trajectories of caries experience of members in dunedin study
what are the DMFS trajectories of the dunedin study?
- 2% 2343 in low trajectory (low DMFS)
- 7% were in medium trajectory (medium DMFS)
- 1% were in high trajectory (high DMFS) - more likely to experience problems in middle age
what difference in caries to people experience as they age?
generally as people get older, more teeth become affected by caries
- teeth also begin to disappear with age
what is a more accurate representation of tooth caries during the life span?
- high rate in early life as baby teeth aren’t built to last. they are less mineralised.
- rate stays relatively constant for the rest of life unless old people go to nursing homes or go to a nursing home and have dementia
how is oral health in young children?
very poor
- Severe Early Childhood Cares (s-ECC) the most important problem by far
- prevalence has not been decreasing
- 16.6% in 2009, 23.3% in 2013
what are the rates and costs of treating children under GA in hospitals?
in 2004: 4,646 NZ children treated
in 2016: 7,650 were treated (65% increase)
- at the dental rate of 0.48 per case, the weighted discharge free of $4752 which is $17.4 million per year
do kids with poor oral health end up as adults in the high caries trajectory? how was this found out?
1037 children born in 1972/73 were in the cohort with a wide range of social, health and psychological data collected
- this graph shows that ECC casts a long shadow
kids 0 dmfs by age 5 - only 1 in 14 ended up in high trajectory
kids who had 5 or more dmfs by age 5, 25% ended up in high trajectory
what things lead to a high decay experience?
- effects of social disadvantage accumulating through life
what sorts of models help us think about common oral health conditions?
accumulation models are a good risk model which applies most to dentistry
- help identify patterns and factors
what were the SES transitions found in the Dunedin study in relation to dental caries?
- the older we get, the more decay we will accumulate - leads to more tooth loss
- if SES is important, high-high group should have best health and low-low should have worst health
adult exposures are more important since we spend more time in adulthood than childhood, meaning that low-high SES people become closer to being like high-high people
what are the rates of 1+ teeth lost due to caries in the members of the dunedin study?
age 26 = 9.3%
age 32 = 20.2%
age 38 = 29.6%
what does this tell us about SES transitions and tooth loss?
higher SES = less tooth loss
low SES = more tooth loss
gradients are very different among SES, and get a lot wider as SES decreases
what are the intergenerational effects of dental caries? do the children of parents with poor health end up having poor oral health?
there was not a lot of work on this done before the dunedin study
- many were blaming the mother for transmitting S mutans bacteria to baby’s mouth
how is family history as a risk factor for dental caries?
family history is a risk factor for almost all diseases of public health importance
- neither genetics not genomics have had much impact to date
family history reflects consequences of:
- genetic variation
- shared environment
- similar beliefs, values, practices
how did mothers self-rated oral health when their child was 5 reflect the childs oral health when they were aged 32?
- more mothers rated their own oral health as very poor in 1977/78 when their child was 5. however you would expect the ‘excellent’ to be a bit lower
- then in 2003/04 the child (who are now aged 32) a lot more of them rated their oral health less than excellent, with most rating it very poor
how can this gradient of mothers and children self-rating of their oral health be explained?
it has nothing to do with mothers giving the decay to the child, but is all about the complex difficulties, exposures, environment and experiences which impact our experiences with chronic diseases
what are the implications for oral health?
- influences on oral health are complex and operate at a number of levels
- public health and preventative implicationns (take a wide and long view. know there are no quick fixes)
- big tobacca and big sugar need close attention and public regulation
- the ottawa charter for health promotion remains as relevant now as it ever was
what does this show?
everything is connected!
e.g. beliegs and parental oral beliefs impact the childs oral beliefs and dental attendance and number of problems by the time they are 38
