Measuring Oral Health and Disease

1
LECTURE 3
2
Measuring Oral Health and Disease
3
Measuring oral disease Morbidity Surveys
Types of surveys

• Cross-sectional prevalence
• Repeated cross-sectional changing
  prevalence/trends
• Longitudinal incidence

4
Cross-sectional study

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

5
Prevalence of traumatic dental injury
6
Prevalence of traumatic dental injury
7
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 (n2520)
• Dental trauma index presence/severity

8
Repeated cross-sectional study

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

9
Trends in edentulism in adults 16 yrs UK
national surveys


Projected
10
Trends in edentulous US adults 75
13.5m
22.0m
11
Percent of Ontario children caries free
12
Mean deft/DMFT scores in Ontario children
13
Percent of 13-14 yr olds with untreated
decayCanadian born versus new immigrants

Time in Canada
14
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

15
Prevalence () of traumatic dental injury at age
14 Newham, UK
Marcenes, 2002
16
Implications

• Prevalence of traumatic injury is high
• Prevalence increasing (?)
• Emerging as significant public health problem

17
Longitudinal study

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

18
Three year incidence of tooth loss in Ontario
adults aged 50 and overLocker et al, 1996
Percent losing one or more teeth
19
Percent losing one or more teeth by smoking
status at baseline
20
Mean number of teeth lost by smoking status at
baseline
21
Measuring oral disease Morbidity Surveys
Types of surveys

• Census measures true population values
• Sample survey estimates population values

22
Sampling and Estimation
Estimates of population values based on samples
are always subject to a degree of error (sampling
error)
23
Population 2ft 4ft 5ft 6ft True
population mean 4.25ft Estimates 24
3.0ft 25 3.5ft 26
4.0ft 45 4.5ft 46
5.0ft 56 5.5ft
Random samples of 2
24
Sampling and Estimation

• Probable accuracy of these estimates assessed
  using
• - standard errors
• - 95 confidence limits

25
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)
26
Sampling and Estimation

• 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)
27
Measuring oral health
28
Types of outcome measure in medicine and dentistry

• Survival/longevity
• death
• tooth loss

29
Types of outcome measure in medicine and dentistry

• Physical/physiological
• number of DS
• LPA

30
Types of outcome measure in medicine and dentistry

• Behavioural/psychosocial
• health
• quality of life

31
Measures of health/quality of life

• subjective states
• perceptions, feelings, behaviours

32
Disease Health Quality of life
Health-related quality of life
33
W.H.O. definition of health1948
A state of complete physical, mental and social
well-being and not just the absence of illness
34
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
35
Biomedical model (Disease) Biopsychosocial
model (Disease, functioning, well-being)
36

• Primary purpose of many treatments is to improve
  a patients functioning and well-being
• E.g. complete denture therapy, osseointegrated
  implant therapy, orthodontic treatment

37
Oral health status indexes

• Oral Health Impact Profile
• Geriatric Oral Health Assessment Index
• Child Oral Health Quality of Life Questionnaire

38
What do they measure?

• Physical function
• ability to chew, speaking, self-care

39
What do they measure?

• Oral symptoms
• pain/discomfort, dry mouth, bad breath

40
What do they measure?

• Emotional well-being
• depression, anxiety, self esteem, ability to
  concentrate

41
What do they measure?

• Social functioning
• relationships, social activities

42
What do they measure?

• Social roles
• work, school, household tasks, child care

43
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.

44
Adults age 50 and overPercent reporting various
problems related to oral disorders
45
Percent of dentate and edentulous with various
problems
46
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.

47
Children aged 11 to 14 yrsPercent reporting
various problems related to oral disorders
48
Emotional well-being and social functioning
scores Children aged 11 14
49

• Multi-item indexes
• Single item global ratings

50
Single item global ratings

• Self-rating of oral health
• excellentpoor
• Satisfaction with oral health
• satisfieddissatisfied

51
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

52
Uses of measures of oral health status (oral
health-related quality of life)

• Clinical trials
• Assess extent to which new therapies improve
  functioning and well-being of patients

53
Pre and post-treatment OHIP scores of implant and
denture patients
Awad et al, 2000
54
Uses of measures of oral health status (oral
health-related quality of life)

• Clinical practice
• Assess patients needs
• Monitor outcomes of therapy

55
Self-ratings of oral health pre and post-treatment