DISTRIBUTION & IMPACT OF DENTAL CARIES & PERIODONTAL DISEASE

define epidemiology

epidemiology: the orderly study of diseases and other conditions in human populations where the group and not the individual is the unit of interest

• Mausner & Kramer 1985

what assumptions does epidemiology have about human diseases and conditions

1. they do not occur at random

2. they have 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 (MacMahon & Pugh 1970)

which studies on the hierarchy of evidence are considered epidemiological studies

how many people globally are affected by oral diseases

• global burden of oral conditions: 3.9 billion people are affected by oral diseases globally

what is the most common oral disease suffered globally

untreated caries of permanent teeth

what is the second most common oral disease suffered globally

severe periodontitis (people who have 2 or more pockets of 6mm or more)

how is dental caries measured

using the DMF index

outline the DMF index

DMF index

• summarises caries and treatment experience in groups

• score of 1 or 0 for each tooth

• final DMFT score is the total of decayed, missing and filled teeth

• decay takes precedence over filled

example of a DMF index

what is the difference in notation between primary and permanent dentitions when writing DMFT

• primary: dmft

• permanent: DMFT

what are advantages of the DMFT index

• relatively easy to apply

• simple to understand

what are disadvantages of DMFT

• age specific

  • cannot compare data from different ages

• does not distinguish between treated and untreated decay

  • no filling, filling in cavity, extracted tooth all score a DMF of 1

• cumulative and irreversible

  • someone with a high DMFT score may have had caries in the past and not currently/ recently

  • the value will never drop therefore not useful to assess if a person’s oral health is changing

• does not distinguish between the severity of disease

• less accurate and useful in adults

  • the status of a tooth reflects dentists’ decisions making rather than indicating disease level

• cannot distinguish if teeth are extracted because of caries or due to other reasons

• does not tell us about the impact of the disease on a person/ group/ population

____ factors for any disease affect the _____________

risk factors for any disease affect the distribution

what are key risk factors for caries

• high carb. diet

• availability of fluoride

• socioeconomic position (SEP)

• genetic susceptibility

how is a disease distributed in the population in terms of trends across…

there are trends across:

• age groups

• geography

• sex

• socioeconomic position

• time (temporal trends)

when was NHS dentistry introduced

1950

now, approximately 1% of all adults are _________

edentulous

• % has decreased massively since mid-late 90s

• from 37-6% from 1968 to 2009

how can the impact of caries on individuals be measured

• interviews

• questionnaires

• Oral Health Related Quality of Life (OHRQoL) questionnaire

if caries level is low, what impact does it have on OHRQoL

if caries level is low then there is a low impact of OHRQoL

what impact does caries have on society

• children: absenteeism, school performance, some speech and language development

• adults: work absenteeism and performance

• cost to economy (productivity losses)

• costs of dental treatment (> £3.2bn pa in England)

what is a potential consequence of small carious lesions

‘false positive’ diagnoses

is caries equally distributed in the community?

no

how can we tackle the parts of the community that caries is restricted to

• these groups appear resistant or unable to change

• need to recognise social determinants of health

• ‘target’ these groups e.g. community programmes like supervised toothbrushing in nurseries

what is the cohort effect regarding fluoride access

• people under 50yo have always had F toothpaste

• therefore generally have lower disease levels so the treatment they need is simple

—

• people over 50yo did not have F when they were younger

• therefore generally more caries when younger but keen to keep their teeth

• so now they have more complex treatment needs therefore greater need for restorative specialists

what are the two broad types of periodontal disease

• gingivitis - reversible inflammation of gingiva

• periodontitis - irreversible loss of attachment between tooth and supporting structures

what are key features of periodontitis

• recession

• pocketing

• bleeding

what symptom can sometimes not be present in those with periodontitis

oedema (non-inflamed gums)

how is gingivitis measured in children

• by visual signs of redness

how is gingivitis measured in adults

• by visual signs of redness

and/ or

• bleeding on probing

what is an issue with probing

• probing is notoriously unreliable as it depends on the probe force

• this becomes a problem in research

how is periodontitis measured

• looking for loss of attachment (as pocket depth), recession or both

what is the index for measuring periodontal disease

BPE

outline the basics of the BPE

• mouth is divided into six sextants

• the worst score for each sextant is recorded

• 8s are excluded

outline the BPE scoring

what BPE score constitutes a periodontitis diagnosis

2 sextants with code 4

how prevalent is gingivitis

• estimates vary: 50-100% of the population affected at any one time

• could be the most common disease in the world

• is it a disease? or just inflammation

what is the trend of gingivitis in children

• children are brushing their teeth better than they used to

• gum inflammation, plaque, calculus have decreased from 2003 to 2013

what is the trend of periodontitis with age

• positive correlation with age

risk factors for any disease affect ____________

distribution

what are risk factors for periodontal disease

• plaque

• tobacco smoking

• (inadequate/ poor) restorative dentistry

• genetics

• immune disorders/ immunity suppression

what other factor shows a relationship with periodontal disease

socioeconomic position

what is the impact of periodontal diseases relative to caries

• periodontal disease generally has less of an impact than caries on individuals

what else is periodontal disease associated with

a negative impact on quality of life

• based on 25 cross sectional studies (Ferreira et al. 2017)

what is the cost of all dental treatment pa in England

> £3.2 billion

how effective is treatment for periodontal diseases

• moderately effective at best

• varies greatly between individuals

• success is based on control of disease and risk factors

what % of people brush their teeth twice daily

75%