4 - Dental caries epidemiology : the prevalence and impact of disease Flashcards Preview

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what is epidemiology?

Epidemiological surveys aim to give an overview of disease levels in the population –
• how many people have decay?
• how much decay do they have?
• which groups have most decay?
• has decay been treated?


What can epidemiological date be used to make?

comparisons, identify treatment needs and plan services or preventive activities at population level


what occurs in a clinical exam?

• Look at an individual patient
• Aim to diagnose all caries
• Additional tests as required (eg. radiographs)
• Outcomes used to treatment plan for individual patient – monitor/restore/extract teeth and offer individualised advice


what occurs in epidemiology?

• Look at population
• Record caries at level specified
by criteria
• No special tests (usually)
• Outcomes used to identify needs of population – monitor changes over time, plan services/ preventive programmes


what is the stage before very early decay?

sub-clinical initial lesions in a dynamic rate of progression/regression


what are the various stages of tooth decay?

-very early stage decay- small lesions detectable only with additional diagnostic aids
-inital decay - clinically detectable enamel lesions with "intact" surfaces
-moderate decay- clinically detectable 'cavities' limited to enamel
-extensive decay - lesions into the pulp/ clinically detectable lesions in dentine


what stages of decay are obvious and assessed in detailed NDIP inspections?

-extensive decay


How do we measure caries in individual teeth?

-sound surface
-enamel caries , no cavitation,- D1
-Cavity in enamel only -D2
-clinically detectable caries into dentine - D3
-treated : restored/ extracted


what is used to record dental decay in a consistent way?

caries index


what is the most commonly used caries index?



what does the DMFT record?

number of decayed, missing and filled teeth


what does the DMFT describe?

describes the number of teeth with "decay experience"


what happen with DMFT over time?

cumulative over time


what can each teeth only be?

one of decayed/missing/filled


what is the order of precedence?



what are crowns included in?

"filled" teeth


what are the variations of DMFT?

• dmft - Decayed, missing and filled DECIDUOUS teeth
•DMFS -Decayed,missingandfilledSURFACES
• dmfs - Decayed, missing and filled surfaces of deciduous teeth
• def - Decayed, extracted and filled deciduous teeth
• D3MFT - Decayed (into dentine), missing and filled teeth


what is clinically detectable in D3 level?

lesions in dentine


what may D3 level be?

may be "cavitated" or "visual;" (grey shadow)


why use D3?

• Level at which restorative treatment indicated
• Also described as “obvious decay”
• More consistent recording


what is inter-examiner reliability?

if more than one clinician looks at the same tooth they would record the same score


what is intra-examiner reliability?

if the same clinician saw the same tooth again they would give it the same score each time


what does DMFT equal?

number of teeth with caries experience


what does DT/DMFT x 100 equal?

% of caries experience which is untreated = indicator of treatment need


what does FT/DMFT x 100 equal?

% caries experience that has been restored = care index


what are the limitations of DMFT?

• Each component has equal weight in index but unequal impact on patient
• Not ideal for mixed dentition
• M may count teeth missing for reasons other than caries
• Exfoliated, Orthodontic extractions, Unerupted, Hypoplasia, Trauma
• Fillings may have been placed for lesions which would not have been
counted as carious
• Trauma, Aesthetics, Hypoplasia
• Decay experience is irreversible – can’t use to measure effectiveness of beneficial interventions


what does standardising survey methodology do?

• Aims to increase consistency between epidemiological surveys
• Sets out standards for the examination
• Criteria for recording disease
• Conventions for recording eg trauma, unerupted teeth


what is the national dental inspection programme?

• School Dental Inspection Programme
• P1s (age 5), P7s (age 11)
• Annual “Basic Inspection” – all P1 and P7 = risk assessment
• 3 categories: urgent dental problem, care needed, no obvious problems
• Alternate years sample from P1/P7 “Detailed Inspection” – dmft P1, DMFT P7


what information is given in NDIP report?

• % “No obvious decay experience”:
>% with DMFT=0
> NOT the same as % caries free
• Average number of teeth affected by decay:
>Mean DMFT
• Trends over time
• % decay treated with fillings
• % decay untreated
• Geographic comparisons (by Health Board)
• Comparison by area deprivation


who is affected most by caries?

deprived populations