Download The Burden of Dental disease in Children Professor Jimmy Steele Newcastle University

The Burden of Dental disease in Children
England, Wales and Northern Ireland
Professor Jimmy Steele
Newcastle University
Why report “burden”
Changes in disease prevalence
• In 1973 caries was so abundant that the
priority had to be to reduce prevalence
• A minority of children now affected by caries
into dentine
• BUT number of teeth affected amongst those
with disease remains unchanged.
Permanent teeth in 15 year olds
Dentinal decay prevalence is less…
Is decay any more concentrated?
2003
%
2013
mean
%
Obvious visual
caries (Code 2V)
32
21
Actual “cavities”
13
11
(Code 2C)
mean
“Actual cavities” here refers to “cavitated” dentinal lesions
Permanent teeth in 15 year olds
Dentinal decay prevalence is less…
Is decay any more concentrated?
2003
2013
%
mean
%
mean
Obvious visual
caries (Code 2V)
32
2.5
21
2.4
Actual “cavities”
13
1.5
11
1.8
(Code 2C)
“Actual cavities” here refers to cavitated dentinal lesions
Is the picture in this 11% more “neglected”?
The implications of “burden”
As opposed to simple caries presence
• Tooth tissue loss, lifetime implications
– Maintenance needs (permanent teeth)
– Restorative cycle (permanent teeth)
– Orthodontic impacts (age 5 and 15)
– Establishing a high risk environment (age 5)
• Immediate effects at 5 and 15
– Family costs and inconvenience
– Service issues (GA, acute services, AB prescription)
• Quality of life impacts immediately and for life
The implications of “burden”
• SERVICE DESIGN
• COSTS
• QUALITY OF LIFE
Take your pick
Defining “burden”
Necessarily arbitrary
• 5+ teeth with obvious decay experience (dft
at age 5 or DMFT at age 15)
• 3+ “Visual caries lesions” (into dentine)
• Any “unrestorable” teeth
• Any PUFA signs (sepsis related to caries)
• Any missing permanent teeth (age 15 only)
• Any of the above
Percentage of 5 year olds with severe or
extensive dental decay, by country
England, Wales and Northern Ireland, 2013
Children aged 5
5+ teeth with obvious decay experience
3+ teeth with decay into dentine
Any unrestorable teeth
Any PUFA signs
Any of these
Unweighted bases
Northern
Total
Ireland
England
Wales
6
10
5
4
13
11
19
7
6
22
13
18
5
5
19
6
11
5
4
13
1,526
493
530
2,549
What would Northern England look like here?
Percentage of 15 year olds with severe or
extensive dental decay, by country
England, Wales and Northern Ireland,
2013
Children aged 15
5+ teeth with obvious decay experience
(high dmft)
3+ teeth with decay into dentine
Any unrestorable teeth
Any PUFA signs
Loss of any permanent teeth due to
decay
Any of these
Unweighted bases
England Wales
Northern
Total
Ireland
8
14
28
9
5
2
2
11
2
2
10
3
3
6
2
2
6
11
13
6
14
1,313
22
554
36
551
15
2,418
Children with a potential “burden”
• 13% of 5 year olds
• 15% of 15 year olds
So about 1 in 7 children are in this group……
Who are the 1 in 7s?
Age 5
Total
England
Wales
Northern Ireland
Male
Boys at 5
Female
Eligible for Free
School Meals
Not eligible
More deprived
0
10
20
Percentage
30
40
50
Age 15Total
England
Wales
NI fillings
Northern Ireland
Male
Girls at 15
Female
Eligible for…
More deprived
Not eligible
0
10
20
Percentage
30
40
50
Behavioural factors linked with burden at age 15
Total
Hygiene helps…..a bit
Brushes at least twice a day
Brushes less than twice a day
Dentist: check-ups
Dentist: only with trouble
Dentist: never
Sugary drinks: less than once a day
Sugary drinks: 1-3 times a day
4+ Sugary drinks
Sugary drinks: 4+ times a day
<1 Water
Water: less than once a day
Water: 1-3 times a day
Water: 4+ times a day
0
10
20
30
Percentage with a caries burden
40
50
Area-based measures
• Output Area Classification (OAC)
• Index of Multiple Deprivation (IMD)
Risk of caries “burden” by IMD quintile
25
20
15
Age 5
10
Age 15
5
0
Least
deprived
Most
deprived
Multivariate analysis
This gets a bit complicated
• Upstream and downstream influences difficult to
separate (more complex modelling approaches can
address this).
• Never cause and effect, all we can see is associations
• Nevertheless confounding can be addressed in a
more straightforward model
• Two stage model used. First a model with all
demographic variables inserted, then behavioural
variables inserted.
Table 4.20 Characteristics significantly associated with severe or extensive
dental decay (burden) among 15 year olds (odds ratios)
Variable
Odds ratio
Country of residence (p<0.001)
England
Wales
Northern Ireland
1
1.87
3.91
Eligibility for free school meals (p=0.002)
Not eligible
Eligible
1
1.99
Pattern of dental attendance (p<0.001)
Check-ups
Only with trouble
1
2.93
Consumption of sugary drinks (p<0.001)
Less than once a day
Four times or more a day
1
2.13
Consumption of water (p=0.014)
Less than once a day
One to three times a day
Four times or more a day
1
0.6
0.59
What does this say?
• Any child can have bad caries – it is not just
deprived children
• BUT deprivation is a major factor associated
with risk
• “Good” health behaviours are associated
with lower risks of disease, though not
anywhere near completely protective
• It matters what a child drinks in a day……
What do gradients now mean?
Risk of caries “burden” by IMD quintile
25
Trend to reducing prevalence
20
15
Age 5
10
Age 15
5
0
Least
deprived
Most
deprived
Other “burdens”
• Trauma not a lot (but deprivation effect?)
• Tooth surface loss – very similar associations to
caries; significant relationships with deprivation,
brushing, attendance and preferred drinks
Is it the same children?
Other “burdens”
• Orthodontic burden……
– Malocclusion is not a disease
– There is not a lot you can do to avoid it
– Treatment is expensive and in demand
– Who gets it……IOTN?
Orthodontic burden”
Percentage of 12 and 15 year olds undergoing
orthodontic treatment, by country and age
England, Wales and Northern Ireland,
2013
Children aged 12, 15
12 years
15 years
Total
England
8
18
13
Wales
8
16
12
Northern Ireland
17
19
18
Total
9
18
13
Orthodontic burden”
Percentage of 12 and 15 year olds with unmet
orthodontic treatment need, by country and age
England, Wales and Northern Ireland, 2013
12 years
15 years
Unmet orthodontic treatment need (dental health
component)
36
20
Unmet orthodontic treatment need (aesthetic component
score 8-10)
10
5
Any unmet orthodontic treatment need
(dental health component or aesthetic component score 810)
37
20
Orthodontic burden”
Percentage of 12 and 15 year olds with unmet
orthodontic treatment need (dental health component),
by eligibility for free school meals
England, Wales and Northern Ireland, 2013
Children aged 12, 15, not undergoing orthodontic
treatment
12 years 15 years
Eligible
40
32
8%
Not eligible
35
17
18%
This suggests that a large majority of the children who may
qualify for orthodontic care are not receiving it……
Why, and does this matter?
The burden is not fair
• 1 in 7 children have a large caries “burden”
• Important social and behavioural associations
• Associations suggest we will not treat our way
out of this problem
• Distribution of orthodontic care asks some
difficult questions
IOTN Aesthetic component….?