Trends in oral health Flashcards
What is epidemiology? (1)
“the orderly study of diseases and other
conditions in human populations where
the group and not the individual is the
unit of interest”
Epidemiology may be viewed as based on two assumptions about human disease… (2)
- … does not occur at random,
- … has causal and preventive factors that can
be identified through systematic investigation of
different subgroups of individuals within a
population in different places or at different
times.”
Uses of epidemiology (3)
- Assess oral health & need for dental services
- Identify causes of disease
- Evaluate effectiveness of care
Importance of epidemiology for you: describes (2)
- levels of dental disease and
* needs of population served by you
Importance of epidemiology for you: distribution of disease (2)
- Determines way you should diagnose
* Determines type of work you will do during week
How do we measure disease? (2)
An index: a systematic method of measuring or
recording a disease or condition from established
criteria
Choice of index depends on (3)
– Type of investigation
– Nature of information required
– Ability to reproduce the findings
Dental conditions measured in surveys (6)
- Caries
- Periodontal disease
- Trauma
- Malocclusion
- Oral cancer
- Fluorosis
Dental caries and treatment experience (5)
DMF / dmf Covered in Y1 Decayed (D or d) - untreated disease Missing due to caries (M or m) Filled due to caries (F or f)
Scoring dmft/ DMFT (5)
Record of previous and current disease Score of 1 given to each D, M or F tooth Usually expressed as D + M + F = total DMFT Max possible score = 28 DMFT or 20 dmft For groups, calculate mean dmft/DMFT
Dental indices - caries (3)
Care index = F x 100
DMF
• Access and utilization of dental care
• Type of dental care provided
Problems with DMF (5)
• Assumes missing and filled teeth were once carious
but could be missing for other reasons (e.g.
periodontal disease or dental trauma)
• Restorations could have been placed for other
reasons (e.g. Preventive Resin Restorations, dental
fractures)
• Assigns equal weight to filled, missing and decayed
• DMF is irreversible (can’t be reduced)
• See lecture in Y2
Dental indices: periodontal disease (3)
Community periodontal index of treatment need (CPITN)
• within NHS adapted & re-named Basic Periodontal Exam
• special blunted probe
Dental indices: dental trauma index (4)
0 Tooth present without any evidence of trauma
1 Unrestored enamel fracture that does not include dentine.
2 Unrestored fracture including enamel and dentine.
3 Unrestored fracture including enamel and dentine with pulp
exposure
4 Missing tooth due to dental trauma
Dental indices: malocclusion - IOTN components (2)
Aesthetic component:
• Grade 1 to Grade 10 = most to least aesthetic
arrangement of the dentition
Dental health component:
• 1 to 5 = no need to great need for treatment
Dental indices: oral cancer
Incidence
= no. of new cases in a given time period
no. at risk
Oral health-related quality of life(5)
• Interviews/questionnaires about experience of mouth
• Included in surveys to supplement clinical data
• Oral Health Impact Profile (OHIP-14) widely used
• Includes items on symptoms, function, social &
emotional aspects
• E.g. > 50% of dentate adults reported an oral problem in the past 12 months, most commonly pain
Global Oral Health (5)
• 60–90% of school children and nearly 100% of adults
have dental cavities.
• Severe periodontal disease is found in 15–20% of middle-aged (35-44 years) adults.
• About 30% of people aged 65–74 have no natural teeth.
• The incidence of oral cancer ranges from one to 10 cases
per 100 000 people.
• 16-40% of children in the age range 6 to12 years old are affected by dental
• provides for the outcome evaluation of national and
community oral health promotion and disease prevention
programmes.
• The data stimulate providers of oral health care in
countries and health authorities to implement preventive oral care programmes by sharing experiences and
ensures data for adjustment of ongoing programmes.
• The information system addresses oral diseases as part of the NCD burdens and it incorporates data on oral
manifestations of HIV/AIDS and oral cancer. trauma.
Trends: variations or differences may be (4)
- Age
- Geographic
- Socioeconomic
- Temporal
International trends (4)
• Differences between countries • Oral disease surveillance systems introduced by WHO in 1960s allows comparisons • From year 2000 database includes 184 countries • WHO & Fédération Dentaire Internationale set a global goal for 2000 of not > 3 DMFT for 12-year-olds - achieved by 68% of countries
Oral cancer: variation in incidence between countries (5)
• E.g. within Asia incidence per 100,000 population is:
– 12.6 in India where oral cancer accounts for up to 40% of all
malignancies among men.
– 4.6 in Thailand
– 0.7 in China
• Worldwide mortality rate for males:
– 3.25 per 100,000 less developed countries
– 2.78 more developed countries
Socio-economic trends: five year olds in UK (3)
7-fold difference in mean dmft in areas
with lowest & highest caries experience:
– dmft in Maidstone Weald = 0.47
– dmft in North Kirklees = 3.69
Socio-economic trends in USA (2)
– poor compared to higher income children:
• have twice the caries
• higher risk of caries remaining untreated
– poor compared to higher income adults:
• higher proportion of untreated caries
• more likely to become edentulous
Trends in ethnicity (4)
• Studies around world have been conducted
to establish trends in ethnicity
• No consensus reached
• Disagreements due to confounding between
ethnicity & socio-economic status
• Data complicated by different dentitions,
assignment of ethnicity, religious differences
& maternal literacy
Temporal trends (3)
• Regional variations persist
• Caries levels in deciduous teeth not improved
since 1993
• Improvements in permanent teeth continued
Implications for dentistry (4)
- Greater specialisation
- Fewer full dentures for GDPs
- More domiciliary care
- Net change in dental workforce?
Oral cancer stats (4)
• 2% of all cancer cases in the UK.
• Incidence = In 2005 there were 4,926 new
cases of oral cancer
• 2006: 1,696 deaths from oral cancer in the UK.
• Survival rate: 50% at 5 years
