Health behaviours and impact on oral health

1
Health behaviours and impact on oral health

• Nigel Nuttall

2
Child Dental Health Survey Questionnaire.

• 5480 questionnaires (1/2 of dentally examined
  sample)
• Questionnaire applied to 5, 8, 12 15 year olds
• Questionnaire usually completed by parent or
  carer
• Not an interview (unlike Adult Dental Health
  Survey)

3
Method
4
Development of Questions concerning Oral Quality
of Life in children

• No existing measures were available at time of
  survey
• Length of questionnaire was an issue
• Age range of sample 5, 8, 12 and 15

5
Development of Questions concerning Oral Quality
of Life in children

• Mirror the impact areas assessed in the Adult
  Dental Health Survey 1998
• Although this does apply an adult
  interpretation to problems experienced by
  children
• Reduce each impact area to one question
• Add a question concerned with General Health

6
Development of Questions concerning Oral Quality
of Life in children

• EXAMPLE
• FUNCTIONAL LIMITATION
• (Adult Dental Health survey 1998)
• In the last 12 months have you felt your SENSE OF
  TASTE has been worsened because of problems with
  your mouth, teeth or gums?
• In the last 12 months have you had trouble
  PRONOUNCING ANY WORDS because of problems with
  your mouth, teeth or gums?

7
Development of Questions concerning Oral Quality
of Life in children

• EXAMPLE
• FUNCTIONAL LIMITATION
• (Childrens Dental Health Survey 2003)
• In the last 12 months has your child had any
  difficulties using their teeth, gums or mouth
  such as problems chewing or talking

8
Development of Questions concerning Oral Quality
of Life in children

• Tested for comprehension by the Qualitative
  Methods Applied to Surveys Unit at the Office for
  National Statistics

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The 8 Impact Questions

• TYPE OF IMPACT QUESTION TOPIC
• Pain Toothache or sore mouth
• Oral function Problems chewing or talking
• Self-confidence Embarrassed, self-conscious,
  worried
• Orally-related activity Affect on childs
  activities
• Emotions Affect on childs emotions
• Social functioning Affect on childs social life
• General health Affect on childs health
• Life overall Affect on childs life overall

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Response Categories
Not At all
Rarely
Occasionally
Fairly Often
Very Often
Dont Know
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Response characteristics

• 61 of questionnaires returned
• 91 of questionnaires completed by parents
• 9 of questionnaires completed by parent
  participant
• 1 of questions were answered Dont Know

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Results
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Response Rate
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Childrens Dental Health Survey Questionnaire
Response Rates 1983-2003
15
Number of impacts experienced
16
Number of impacts reported by age
17
Number of impacts reported by age
18
Nature of impacts experienced
19
The nature of impact 5 year olds
20
The nature of impact 8 year olds
21
The nature of impact 12 year olds
22
The nature of impact 15 year olds
23
Observed Impact Hierarchy
Pain
Function Self-confidence Orally related
activity Emotions
Socialising Health Life in general
24
Number of impacts experienced by age and by
social class
25
Number of impacts reported by age sex
26
Number of impacts reported by age social class
27
Number of impacts experienced by caries experience
28
Number of impacts reported by age experience of
decay in primary teeth
29
Number of impacts reported by age experience of
decay in permanent teeth
30
Number of impacts experienced by attendance
31
Experience of some impact by reported attendance
32
Nature of impacts experienced by attendance in 12
year olds
33
The nature of impact 12 year olds by attendance
behaviour
34
Conclusions

• 3/4 children were reported not to have
  experienced any of the problems covered by the
  questionnaire.
• Of the 1/4 who did experience a problem, most
  were only reported to have experienced a single
  problem and for most this was the experience of
  pain.
• The most marked relationship between impact and
  any other factor examined in the survey was with
  reported attendance of the children symptomatic
  attenders were reported to experience more
  problems

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Oral health behaviours

• Deborah White

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Outline

• Reported oral health behaviours
• Oral health behaviours and gingival health
• Parental beliefs about decay
• Parental preferences for treatment

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Tooth brushing

• How often?
• Who brushes?
• Whats used?
• Changes since 1983

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Frequency of tooth brushing by age, UK 2003
39
Proportion of boys and girls brushing twice a
day, UK 2003
40
Proportion of children brushing twice a day (UK
1983, 1993, 2003)
41
Who brushes childrens teeth?
42
Use of tooth brushing products
43
Use of other oral hygiene products
44
Comparison with adult use of oral hygiene
products reported in 1998
52 of adults reported use of other dental
hygiene products (42 in 16-24 age group)
45
Use of fluoride supplements by age and country
46
Gingival health of 5-year-olds and who brushes
teeth
47
Brushing frequency and plaque
48
15-year-olds with gingivitis
49
Parental beliefs about the cause and prevention
of decay

• Questions asked since 1973
• What do you think makes teeth decay (or go bad)?
• What do you think can be done to stop teeth
  decaying (or going bad)?
• Discrepancy between cause and what can be done
• Cause little change since 1993
• Prevention less reliance on the role of the
  dentist and more on self-care

50
Treatment preferences

• If your child had a bad back tooth and it was not
  a baby (milk) tooth but a second (permanent)
  tooth, would you rather it was filled or taken
  out?
• If your child had a bad baby tooth and it was not
  a second (permanent) tooth, would you rather it
  was filled or taken out or left alone?

51
Parents preferring filling in permanent back tooth
52
Treatment preferences for primary teeth
53
Conclusions

• Oral hygiene awareness is improving but there are
  social class differences
• A wide range of oral health products are used by
  children
• Trend towards parental preference for restoration
  rather than extraction of their childs permanent
  teeth
• Parents are equivocal regarding the treatment of
  primary teeth