LECTURE 3
Measuring Oral Health and Disease
Measuring oral disease:  Morbidity Surveys <ul><li>Cross-sectional – prevalence </li></ul><ul><li>Repeated cross-sectional...
Cross-sectional study <ul><li>Sample of population of interest examined at  one point  in time </li></ul>
Prevalence of traumatic dental injury 16.5% 14 US Kaste, 1996 17.0% 14 UK O’Brien, 1994 Prevalence Age Country Study
Prevalence of traumatic dental injury 43.8% 14 Newham Marcenes, 202 34.0% 11-14 Salford Hamilton, 1997 Prevalence Age Coun...
Assessing prevalence of traumatic dental injury <ul><li>Six Ontario communities </li></ul><ul><ul><li>Durham, York, Hamilt...
Repeated cross-sectional study <ul><li>Different  samples from the same population studied at  different  points in time <...
Trends in edentulism in adults 16 yrs +: UK national surveys * * * Projected
Trends in % edentulous: US adults 75+ 13.5m 22.0m
Percent of Ontario children caries free
Mean deft/DMFT scores in Ontario children
Percent of 13-14 yr olds with untreated decay Canadian born versus new immigrants % Time in Canada
Implications of caries trends <ul><li>caries declined but rates now stabilizing; natural level of decay </li></ul><ul><li>...
Prevalence (%) of traumatic dental injury at age 14: Newham, UK Marcenes, 2002
Implications <ul><li>Prevalence of traumatic injury is high </li></ul><ul><li>Prevalence increasing (?) </li></ul><ul><li>...
Longitudinal study <ul><li>Same  sample from the population of interest examined at  different  points in time </li></ul>
Three year incidence of tooth loss in Ontario adults aged 50 and over Locker et al, 1996 Percent losing one or more teeth:...
Percent losing one or more teeth by smoking status at baseline
Mean number of teeth lost by smoking status at baseline
Measuring oral disease:  Morbidity Surveys <ul><li>Census – measures  true  population values </li></ul><ul><li>Sample sur...
Sampling and Estimation Estimates of population values based on samples are always subject to a degree of  error  (samplin...
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 ...
Sampling and Estimation <ul><li>Probable accuracy of these estimates assessed using: </li></ul><ul><li>- standard errors  ...
Random sample survey of 1000 people: 25% of sample are edentulous Standard error = 1.4% 95% confidence interval = 22.2%-27...
Sampling and Estimation <ul><li>Therefore, we can say with 95% certainty that the estimate +/- 2 standard errors will cont...
Measuring oral health
Types of outcome measure in medicine and dentistry <ul><li>Survival/longevity </li></ul><ul><ul><li>death </li></ul></ul><...
Types of outcome measure in medicine and dentistry <ul><li>Physical/physiological </li></ul><ul><ul><li>number of DS </li>...
Types of outcome measure in medicine and dentistry <ul><li>Behavioural/psychosocial </li></ul><ul><ul><li>health </li></ul...
Measures of health/quality of life <ul><li>subjective states </li></ul><ul><li>perceptions, feelings, behaviours </li></ul>
Disease Health Quality of life Health-related quality of life
W.H.O. definition of health 1948 A state of complete physical, mental and social well-being and not just the absence of il...
Contemporary definition of oral health A standard of health of the oral and related tissues that contributes to overall we...
Biomedical model (Disease) Biopsychosocial model (Disease, functioning, well-being)
<ul><li>Primary purpose of many treatments is to improve a patient’s functioning and well-being </li></ul><ul><li>E.g. com...
Oral health status indexes <ul><li>Oral Health Impact Profile </li></ul><ul><li>Geriatric Oral Health Assessment Index </l...
What do they measure? <ul><li>Physical function </li></ul><ul><ul><li>ability to chew, speaking, self-care </li></ul></ul>
What do they measure? <ul><li>Oral symptoms </li></ul><ul><ul><li>pain/discomfort, dry mouth, bad breath </li></ul></ul>
What do they measure? <ul><li>Emotional well-being </li></ul><ul><ul><li>depression, anxiety, self esteem, ability to conc...
What do they measure? <ul><li>Social functioning </li></ul><ul><ul><li>relationships, social activities </li></ul></ul>
What do they measure? <ul><li>Social roles </li></ul><ul><ul><li>work, school, household tasks,  child care </li></ul></ul>
Oral Health Impact Profile <ul><li>Over the past 3 months, how often have you: </li></ul><ul><ul><li>had difficulty chewin...
Adults age 50 and over: Percent reporting various problems related to oral disorders 12.4% Felt depressed 24.8% Self-consc...
Percent of dentate and edentulous with various problems
Child Oral Health Quality of Life Questionnaire <ul><li>Over the past 3 months, how often have you: </li></ul><ul><ul><li>...
Children aged 11 to 14 yrs: Percent reporting various problems related to oral disorders 45.1% Concerned about what people...
Emotional well-being and social functioning scores: Children aged 11 –14
<ul><li>Multi-item indexes </li></ul><ul><li>Single item global ratings </li></ul>
Single item global ratings <ul><li>Self-rating of oral health </li></ul><ul><ul><li>excellent………poor </li></ul></ul><ul><l...
Uses of measures of oral health status (oral health-related quality of life) <ul><li>Population surveys </li></ul><ul><ul>...
Uses of measures of oral health status (oral health-related quality of life) <ul><li>Clinical trials </li></ul><ul><ul><li...
Pre and post-treatment OHIP scores of implant and denture patients Awad et al, 2000
Uses of measures of oral health status (oral health-related quality of life) <ul><li>Clinical practice </li></ul><ul><ul><...
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 ...
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trauma dental

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traumas dentales en niños

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trauma dental

  1. 1. LECTURE 3
  2. 2. Measuring Oral Health and Disease
  3. 3. Measuring oral disease: Morbidity Surveys <ul><li>Cross-sectional – prevalence </li></ul><ul><li>Repeated cross-sectional – changing prevalence/trends </li></ul><ul><li>Longitudinal – incidence </li></ul>Types of surveys:
  4. 4. Cross-sectional study <ul><li>Sample of population of interest examined at one point in time </li></ul>
  5. 5. Prevalence of traumatic dental injury 16.5% 14 US Kaste, 1996 17.0% 14 UK O’Brien, 1994 Prevalence Age Country Study
  6. 6. Prevalence of traumatic dental injury 43.8% 14 Newham Marcenes, 202 34.0% 11-14 Salford Hamilton, 1997 Prevalence Age Country Study
  7. 7. Assessing prevalence of traumatic dental injury <ul><li>Six Ontario communities </li></ul><ul><ul><li>Durham, York, Hamilton, Peel, Simcoe, Guelph </li></ul></ul><ul><li>Random sample of 12 schools in each </li></ul><ul><li>Examine all Grade 8 students (n=2520) </li></ul><ul><li>Dental trauma index – presence/severity </li></ul>
  8. 8. Repeated cross-sectional study <ul><li>Different samples from the same population studied at different points in time </li></ul>
  9. 9. Trends in edentulism in adults 16 yrs +: UK national surveys * * * Projected
  10. 10. Trends in % edentulous: US adults 75+ 13.5m 22.0m
  11. 11. Percent of Ontario children caries free
  12. 12. Mean deft/DMFT scores in Ontario children
  13. 13. Percent of 13-14 yr olds with untreated decay Canadian born versus new immigrants % Time in Canada
  14. 14. Implications of caries trends <ul><li>caries declined but rates now stabilizing; natural level of decay </li></ul><ul><li>80% of decay in 20% of children </li></ul><ul><li>target high risk, ‘hard-to-reach’ groups to effect further declines </li></ul>
  15. 15. Prevalence (%) of traumatic dental injury at age 14: Newham, UK Marcenes, 2002
  16. 16. Implications <ul><li>Prevalence of traumatic injury is high </li></ul><ul><li>Prevalence increasing (?) </li></ul><ul><li>Emerging as significant public health problem </li></ul>
  17. 17. Longitudinal study <ul><li>Same sample from the population of interest examined at different points in time </li></ul>
  18. 18. Three year incidence of tooth loss in Ontario adults aged 50 and over Locker et al, 1996 Percent losing one or more teeth: 19.4% Females 27.8% Males 23.2% All subjects
  19. 19. Percent losing one or more teeth by smoking status at baseline
  20. 20. Mean number of teeth lost by smoking status at baseline
  21. 21. Measuring oral disease: Morbidity Surveys <ul><li>Census – measures true population values </li></ul><ul><li>Sample survey – estimates population values </li></ul>Types of surveys:
  22. 22. Sampling and Estimation Estimates of population values based on samples are always subject to a degree of error (sampling error)
  23. 23. 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
  24. 24. Sampling and Estimation <ul><li>Probable accuracy of these estimates assessed using: </li></ul><ul><li>- standard errors </li></ul><ul><li>- 95% confidence limits </li></ul>
  25. 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. 26. Sampling and Estimation <ul><li>Therefore, we can say with 95% certainty that the estimate +/- 2 standard errors will contain the true population value </li></ul>(95% certain that the prevalence of edentulism in the population lies between 22.2% and 27.8%)
  27. 27. Measuring oral health
  28. 28. Types of outcome measure in medicine and dentistry <ul><li>Survival/longevity </li></ul><ul><ul><li>death </li></ul></ul><ul><ul><li>tooth loss </li></ul></ul>
  29. 29. Types of outcome measure in medicine and dentistry <ul><li>Physical/physiological </li></ul><ul><ul><li>number of DS </li></ul></ul><ul><ul><li>LPA </li></ul></ul>
  30. 30. Types of outcome measure in medicine and dentistry <ul><li>Behavioural/psychosocial </li></ul><ul><ul><li>health </li></ul></ul><ul><ul><li>quality of life </li></ul></ul>
  31. 31. Measures of health/quality of life <ul><li>subjective states </li></ul><ul><li>perceptions, feelings, behaviours </li></ul>
  32. 32. Disease Health Quality of life Health-related quality of life
  33. 33. W.H.O. definition of health 1948 A state of complete physical, mental and social well-being and not just the absence of illness
  34. 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. 35. Biomedical model (Disease) Biopsychosocial model (Disease, functioning, well-being)
  36. 36. <ul><li>Primary purpose of many treatments is to improve a patient’s functioning and well-being </li></ul><ul><li>E.g. complete denture therapy, osseointegrated implant therapy, orthodontic treatment </li></ul>
  37. 37. Oral health status indexes <ul><li>Oral Health Impact Profile </li></ul><ul><li>Geriatric Oral Health Assessment Index </li></ul><ul><li>Child Oral Health Quality of Life Questionnaire </li></ul>
  38. 38. What do they measure? <ul><li>Physical function </li></ul><ul><ul><li>ability to chew, speaking, self-care </li></ul></ul>
  39. 39. What do they measure? <ul><li>Oral symptoms </li></ul><ul><ul><li>pain/discomfort, dry mouth, bad breath </li></ul></ul>
  40. 40. What do they measure? <ul><li>Emotional well-being </li></ul><ul><ul><li>depression, anxiety, self esteem, ability to concentrate </li></ul></ul>
  41. 41. What do they measure? <ul><li>Social functioning </li></ul><ul><ul><li>relationships, social activities </li></ul></ul>
  42. 42. What do they measure? <ul><li>Social roles </li></ul><ul><ul><li>work, school, household tasks, child care </li></ul></ul>
  43. 43. Oral Health Impact Profile <ul><li>Over the past 3 months, how often have you: </li></ul><ul><ul><li>had difficulty chewing? </li></ul></ul><ul><ul><li>been irritable with others? </li></ul></ul><ul><ul><li>been unable to work to your full capacity? </li></ul></ul><ul><ul><li>been self-conscious? </li></ul></ul><ul><li>… because of problems with teeth/mouth/dentures. </li></ul>
  44. 44. 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
  45. 45. Percent of dentate and edentulous with various problems
  46. 46. Child Oral Health Quality of Life Questionnaire <ul><li>Over the past 3 months, how often have you: </li></ul><ul><ul><li>missed school? </li></ul></ul><ul><ul><li>been teased by other children? </li></ul></ul><ul><ul><li>argued with parents/siblings? </li></ul></ul><ul><ul><li>been concern about what other people think? </li></ul></ul><ul><li>… because of problems with your teeth or mouth. </li></ul>
  47. 47. 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
  48. 48. Emotional well-being and social functioning scores: Children aged 11 –14
  49. 49. <ul><li>Multi-item indexes </li></ul><ul><li>Single item global ratings </li></ul>
  50. 50. Single item global ratings <ul><li>Self-rating of oral health </li></ul><ul><ul><li>excellent………poor </li></ul></ul><ul><li>Satisfaction with oral health </li></ul><ul><ul><li>satisfied………dissatisfied </li></ul></ul>
  51. 51. Uses of measures of oral health status (oral health-related quality of life) <ul><li>Population surveys </li></ul><ul><ul><li>Assess extent to which oral disorders compromise the functioning and well-being of populations </li></ul></ul>
  52. 52. Uses of measures of oral health status (oral health-related quality of life) <ul><li>Clinical trials </li></ul><ul><ul><li>Assess extent to which new therapies improve functioning and well-being of patients </li></ul></ul>
  53. 53. Pre and post-treatment OHIP scores of implant and denture patients Awad et al, 2000
  54. 54. Uses of measures of oral health status (oral health-related quality of life) <ul><li>Clinical practice </li></ul><ul><ul><li>Assess patients’ needs </li></ul></ul><ul><ul><li>Monitor outcomes of therapy </li></ul></ul>
  55. 55. 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-treatment Pre-treatment
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