Trends in caries and changes in disease presentation

1
Trends in caries and changes in disease
presentation

• Professor Nigel Pitts
• Dental Health Services Research Unit University
  of Dundee

2
Trends in caries changes in disease
presentationOverview

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

3
Introduction

• A personal thanks to all concerned in the CDH2003
  Consortium and the wider collaborations.
• We should recognise that the prevalence and
  experience of tooth decay (dental caries) across
  the UK population is still seen as a key measure,
  both in assessing oral health and the prospects
  for future oral health.
• I will summarise and explain the CDH 2003 UK
  results for dental caries, other speakers will
  explore results for Countries and socio-economic
  aspects

4
Trends in caries changes in disease
presentationOverview

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

5
Dental caries the disease process measurement

• Before considering the results as trends over
  decades, it is important to understand
• the dynamic nature of the initially reversible
  disease process,
• the conventions for measuring the disease
• how these have evolved over the last decades
• Although details of the methodology may not seem
  vital to interpreting the results, apparently
  trivial differences in diagnostic criteria may
  produce clinically significant differences in the
  results
• Training of examining teams is both important and
  challenging thanks to the Consortium
  examiners

6
Pathogenesis of Dental Caries (biological
balances)
ENAMEL
mouth
inside of tooth
Demineralisation Re-mineralisation
7
From Figure 1 2003 terminology for dental decay
(caries)
obvious decay experience
(d3mft/D3MFT)
decay into dentine
established decay
Unseen dentine decay
excludes all enamel lesions
Unseen enamel Decay
early stage decay
Visible enamel decay
very early stage decay
Sub-clinical decay
8
Recording visual caries at the dentine level
DENTISTS TERMS
SIMPLER TERMS
Traditional indicator now termed Proportion
with no obvious decay experience
Pulpal decay
obvious decay into dentine
severe decay
Dentine decay
established decay
Unseen dentine decay
Groups and Individuals with No Obvious Decay
should NOT be called Caries Free
9
From Figure 1 2003 terminology for dental decay
(caries)
obvious decay experience for trends
comparisons ( d3cmft/D3cMFT)
decay into dentine 2003b estimate for trends
comparisons cavities d3c/D3c
established decay
early stage decay
very early stage decay
10
From Figure 1 2003 terminology for dental
decay (caries)
proportion with obvious decay
experience ( d3cvmft/D3cvMFT)
decay into dentine 2003a more complete
estimate for 2003 cavities AND visual
dentine caries (d3cv/D3cv)
established decay
early stage decay
very early stage decay
11
Trends in caries changes in disease
presentationOverview

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

12
National Surveys of Child Dental Health and caries

• Previous surveys in this unique national series
• 1973 England Wales
• 1983 United Kingdom
• 1993 United Kingdom
• 2003 United Kingdom
• Previously ages have ranged through 5-15 years
• In 2003 restricted to key ages 5,8,12 15 years
• Contrast between the decennial National Surveys
  and the complementary BASCD/NHS Surveys

13
Trends in caries changes in disease
presentationOverview

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

14
Trend data for caries using historical criteria
Good News

• Improvements seen in permanent teeth amongst the
  older children
• Consistent evidence of improvements in the mean
  caries status and the pattern of care are seen
• Careful not to be complacent when looking at the
  values for those with disease experience at this
  diagnostic level and those at the tail of the
  distribution.

15
Trend data for caries using historical criteria
Good News

• Proportion of children with obvious decay
  experience in permanent teeth by age (United
  Kingdom, 1983, 1993, 2003b)

16
Trend data for caries using historical criteria
Good News

• Proportion of children with obvious decay
  experience in permanent teeth by age (United
  Kingdom, 1983, 1993, 2003b)

17
Trend data for caries using historical criteria
Good News
Proportion with obvious decay experience in
permanent teeth

18
Trend data for caries using historical criteria
Good News

• Mean number of permanent teeth with obvious decay
  experience by age (United Kingdom, 1983, 1993,
  2003b)

19
Trend data for caries using historical criteria
Good News
Proportion of obvious decay experience which is
filled permanent teeth

20
Trend data for caries using historical criteria
Good News ?

• Mean number of permanent teeth with obvious
  decay experience in children with obvious decay
  experience by age (UK, 1993, 2003b)

21
Trend data for caries using historical
criteriaNot such Good News

• The lack of significant oral health improvement
  seen in the 5 and 8 year old children
• A continuing decline in the proportion of teeth
  with extensive lesions that have been restored
• Note
• This age group is seen as the bell-weather to
  discern early-on the current trend, rather than
  the historical outcome of past activity seen in
  older cohorts
• The burden of disease in those most affected is a
  significant issue and the inequalities are stark

22
Trend data for caries using historical
criteriaNot such Good News

• Proportion of children with obvious decay
  experience in primary teeth by age (United
  Kingdom, 1983, 1993, 2003b)

23
Trend data for caries using historical criteria
Not Such Good News
Proportion with obvious decay experience in
primary teeth

24
Trend data for caries using historical
criteriaNot such Good News

• Mean number of primary teeth with obvious decay
  experience by age (United Kingdom, 1983, 1993,
  2003b)

25
Trends in caries changes in disease
presentationOverview

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

26
Changes in dentinal decay disease
presentationImpact of collecting data on visual
dentine caries

• Data collected in 2003 is presented both with (a)
  and without (b) visual dentine caries in addition
  to the traditional level of dentine cavities.
• The condition for the examinations in schools
  (with a daray light and absence of the facilities
  of a dental surgery to dry the teeth more
  thoroughly, or even to transilluminate and take
  radiographs) will mean that, even including
  visual dentine caries, the survey will
  under-record dentine caries as compared to a
  clinician in a surgery.
• The criteria are for a shadow or grey
  discolouration indicative of dentine caries,
  without frank cavitation

27
Changes in dentinal decay disease
presentationImpact of collecting data on visual
dentine caries
Proportion with obvious decay in permanent teeth

• -

28
Changes in dentinal decay disease
presentationImpact of collecting data on visual
dentine caries

Mean number of permanent teeth with obvious decay
29
Changes in dentinal decay disease
presentationImpact of collecting data on visual
dentine caries

• Mean number of permanent teeth with
  obvious decay
• experience in those with decay experience

30
Changes in dentinal decay disease
presentationImpact of collecting data on visual
dentine caries

• Proportion with obvious decay in primary
  teeth

31
Changes in dentinal decay disease
presentationThe caries situation in children in
2003

• The 2003a results (with visual dentine caries
  included) provide more contemporary estimates of
  dentine caries experience, but it is difficult to
  know what the trend pattern is (until 2013)
• BASCD coordinated surveys have used this type of
  criteria since 1992
• Remember that all these estimates EXCLUDE caries
  in enamel that clinicians score and that are the
  focus of secondary preventive care.

32
Trends in caries changes in disease
presentationOverview

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

33
Implications for modern caries management

• Evolving care philosophies
• Moves away from the Restorative focus
• Moves towards a more Preventive focus
• Complications of issue of non-restoring primary
  teeth
• Those with
• d3cvmft 0 or
• D3cvMFT 0
• are NOT free of disease or caries immune,
  remember the disease process, the diagnostic
  thresholds used and look at the caries prevalence
  estimates with increasing age

34
ICDAS-II at 2005 International Caries Detection
Assessment System see Community Dental Health
2004 21193-198
Education
ICDAS Clinical Visual Criteria
35
Implications for modern caries management

• Need for upstream public health interventions
• Need for effective oral health promotion linked
  to general health promotion
• Need for joined-up primary care with effective
  interventions for the youngest children before
  they attend the dental services
• Need for child-friendly, preventively oriented
  and clinically effective dental services
  available to children, particularly (but not
  exclusively) for those with high levels of caries
  and who are high caries risk

36
Trends in caries changes in disease
presentationSummary

• Introduction
• Dental caries the disease process measurement
• National Surveys of Child Dental Health and
  caries
• Trend data for caries using historical criteria
• Good News
• Not such Good News
• Changes in dentinal decay and disease
  presentation
• Impact of collecting data on visual dentine
  caries
• The caries situation in children in 2003
• Implications for modern caries management

37
Acknowledgements Disclaimer

• Thanks are due to
• All my colleagues within the CDH2003 Consortium
• and (without whom no survey)
• The examining teams
• The parents and their children for participating
• The Schools and Education Authorities
• The supporting Health Departments
• Note
• This work was undertaken by a consortium
  comprising the Office for National Statistics and
  the Dental Schools of the Universities of
  Birmingham, Cardiff, Dundee and Newcastle and the
  Dental Health Services Research Unit, Dundee who
  received funding from the United Kingdom Health
  Departments the views expressed are those of the
  authors and not necessarily those of the Health
  Departments.