trauma dental

LECTURE 3

Measuring Oral Health and Disease

Measuring oral disease:

Morbidity Surveys

• Cross-sectional – prevalence

• Repeated cross-sectional – changing prevalence/trends

• Longitudinal – incidence

Types of surveys:

Cross-sectional study

• Sample of population of interest examined at one point in time

Prevalence of traumatic dental injury

16.5%14USKaste, 1996

17.0%14UKO’Brien, 1994

PrevalenceAgeCountryStudy

Prevalence of traumatic dental injury

43.8%14NewhamMarcenes, 202

34.0%11-14SalfordHamilton, 1997

PrevalenceAgeCountryStudy

Assessing prevalence of traumatic dental injury

• Six Ontario communities– Durham, York, Hamilton, Peel, Simcoe, Guelph

• Random sample of 12 schools in each

• Examine all Grade 8 students (n=2520)

• Dental trauma index – presence/severity

Repeated cross-sectional study

• Different samples from the same population studied at different points in time

Trends in edentulism in adults 16 yrs +: UK national surveys

37%

29%

20%

13%

8%5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1968 1978 1988 1998 2008 2018

**

* Projected

Trends in % edentulous: US adults 75+

43.939.5

35.130.7

05

10152025

3035404550

1991 2000 2010 2020

13.5m 22.0m

Percent of Ontario children caries free

0

10

20

30

40

50

60

70

80

1972 1974 1980 1984 1990 1994

Age 5 Age 13

Mean deft/DMFT scores in Ontario children

0

1

2

3

4

5

6

1972 1974 1980 1984 1990 1994

Age 5 Age 13

Percent of 13-14 yr olds with untreated decayCanadian born versus new immigrants

0

5

10

15

20

25

30

Canadian born >6 yrs 3-5 yrs <2 yrs

%

Time in Canada

Implications of caries trends

• caries declined but rates now stabilizing; natural level of decay

• 80% of decay in 20% of children• target high risk, ‘hard-to-reach’

groups to effect further declines

Prevalence (%) of traumatic dental injury at age 14: Newham, UK

0

5

10

15

20

25

30

35

40

45

50

1995 1999

Marcenes, 2002

Implications

• Prevalence of traumatic injury is high

• Prevalence increasing (?)• Emerging as significant public

health problem

Longitudinal study

• Same sample from the population of interest examined at different points in time

Three year incidence of tooth loss in Ontario adults aged 50 and over

Locker et al, 1996

19.4%Females

27.8%Males

23.2%All subjects

Percent losing one or more teeth:

Percent losing one or more teeth by smoking status at baseline

22.4 22.3

27

0

5

10

15

20

25

30

35

Never smoked Previous smoker Current smoker

Mean number of teeth lost by smoking status at baseline

0.360.46

0.79

00.10.20.30.40.5

0.60.70.80.9

1

Never smoked Previous smoker Current smoker

Measuring oral disease:

Morbidity Surveys

• Census – measures true population values

• Sample survey – estimates population values

Types of surveys:

Sampling and Estimation

Estimates of population values based on samples are always subject to a degree of error (sampling error)

Population: 2ft 4ft 5ft 6ft

True population mean = 4.25ft

Estimates*: 2+4 = 3.0ft

2+5 = 3.5ft

2+6 = 4.0ft

4+5 = 4.5ft

4+6 = 5.0ft

5+6 = 5.5ft

*Random samples of 2


• Probable accuracy of these estimates assessed using:

- standard errors

- 95% confidence limits

Random sample survey of 1000 people:

25% of sample are edentulous

Standard error = 1.4%

95% confidence interval = 22.2%-27.8%

(25% + 2 x standard error)


• Therefore, we can say with 95% certainty that the estimate +/- 2 standard errors will contain the true population value

(95% certain that the prevalence of edentulism in the population lies between 22.2% and 27.8%)

Measuring oral health

Types of outcome measure in medicine and dentistry

• Survival/longevity– death– tooth loss


• Physical/physiological– number of DS– LPA


• Behavioural/psychosocial– health– quality of life

Measures of health/quality of life

• subjective states

• perceptions, feelings, behaviours

Disease

Health

Quality of life

Health-related quality of life

W.H.O. definition of health1948

A state of complete physical, mental and social well-being and not just the absence of illness

Contemporary definition of oral health

A standard of health of the oral and related tissues that contributes to overall well-being by enabling individuals to eat, communicate and socialize with others without discomfort and embarrassment, and which allows them to participate fully in their chosen social roles

Biomedical model

(Disease)

Biopsychosocial model

(Disease, functioning, well-being)

• Primary purpose of many treatments is to improve a patient’s functioning and well-being

E.g. complete denture therapy, osseointegrated implant therapy, orthodontic treatment

Oral health status indexes

• Oral Health Impact Profile

• Geriatric Oral Health Assessment Index

• Child Oral Health Quality of Life Questionnaire

What do they measure?

• Physical function

–ability to chew, speaking, self-care


• Oral symptoms

–pain/discomfort, dry mouth, bad breath


• Emotional well-being

–depression, anxiety, self esteem, ability to concentrate


• Social functioning

–relationships, social activities


• Social roles

– work, school, household tasks, child care

Oral Health Impact Profile

Over the past 3 months, how often have you:

-had difficulty chewing?

-been irritable with others?

-been unable to work to your full capacity?

-been self-conscious?

…because of problems with teeth/mouth/dentures.

Adults age 50 and over:Percent reporting various problems

related to oral disorders

12.4%Felt depressed

24.8%Self-conscious

41.8%Pain with hot/cold

32.5%Difficulty chewing

Percent of dentate and edentulous with various problems

1511

2

39

33

14

05

101520253035404550

Avoid some foods Slow eating Eat alone

Dentate Edentulous

Child Oral Health Quality of Life Questionnaire

Over the past 3 months, how often have you:

-missed school?

-been teased by other children?

-argued with parents/siblings?

-been concern about what other people think?

…because of problems with your teeth or mouth.

Children aged 11 to 14 yrs:Percent reporting various problems

related to oral disorders

45.1%Concerned about what people think

22.9%Argued with family

32.5%Been teased

92.8%Missed school

Emotional well-being and social functioning scores: Children aged 11 –14

012345678

Pediatric patients Orthodonticpatients

Oro-facial patients

Emotional well-being Social functioning

• Multi-item indexes

• Single item global ratings

Single item global ratings

• Self-rating of oral healthexcellent………poor

• Satisfaction with oral healthsatisfied………dissatisfied

Uses of measures of oral health status (oral health-related quality of life)

• Population surveys

– Assess extent to which oral disorders compromise the functioning and well-being of populations


• Clinical trials

– Assess extent to which new therapies improve functioning and well-being of patients

Pre and post-treatment OHIP scores of implant and denture patients

50

60

70

80

90

100

110

Pre-treatment Post-treatment

Implant Denture

Awad et al, 2000


• Clinical practice

– Assess patients’ needs– Monitor outcomes of therapy

Self-ratings of oral health pre and post-treatment

27.0%56.9%Fair/poor

30.2%23.6%Good

42.8%19.6%Excellent/Very good

Post-treatmentPre-treatment

trauma dental

Health & Medicine