Download 95% CI

Caries Experience and Treatment Need among
6- to 17-year old Psychiatric Patients
Schüler I.M., Bock B., Filz Ch., Rudovsky M., Heinrich-Weltzien R.
119
Department of Preventive Dentistry and Paediatric Dentistry, University Hospital Jena (Germany)
Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Jena (Germany)
Aim
Analysing caries experience and treatment need of patients hospitalized at the Child and Adolescent Psychiatric Clinic.
Material and Methods
 81 patients, 64.4% (n=52) male, hospitalized between 04/2013 and 11/2014 at the Child and Adolescent Psychiatric Clinic of Jena University Hospital were
included.
 Patient’s age ranged between 6 and 17 years (mean age: 10.6 years, SD=2.4 years).
 One dentist provided all oral examinations at the patient's bedside.
 Caries was scored by WHO-criteria.
 Diagnosis of mental disorders and applied medication were collected from the medical records.
 Mental disorders were diagnosed and coded following the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the
c
d
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
 This study, as part of a larger trial, was registered at the German Registry of Clinical Trials (DRKS00004737).
 Data were analysed using MS Excel and SPSS 21.
Results
 Caries prevalence was 60.5% (95% CI: 49.86 71.14) in the permanent and 85.7% (95% CI:
75.91-95.51) in the primary dentition.
 Compared to regional epidemiological data
(dmft of 6 year olds = 2.56; DMFT of 12 year
olds = 0.83; DMFT of 15 years olds = 1.78)*,
caries experience in hospitalized children
and adolescents is higher (dmft = 3.63 and
DMFT = 2.32).
 Untreated carious lesions in both dentitions
were observed in the majority of children;
on average every child suffering from 1.8
decayed teeth in the primary or permanent
dentition (Table 1, 2).
 Acute, stressful life events (6 Axis 5; DSM IV)
and Attention Deficit Hyperactivity Disorder
(ADHD) Medication are associated with
highest caries experience and presence of
untreated dental caries lesions in both
dentitions (Table 1,2).
 Care Index of patients was 39.19% (95% CI:
25.54-52.68) in the primary dentition and
19.34% (95% CI: 10.74-27.94) in the
permanent dentition.
 Highest Care Index was found in patients
receiving antipsychotic medication: 52.78%
(95% CI: 38.81-66.75) in the primary
dentition and 30.24% (95% CI: 20.24-40.24)
in the permanent dentition.
 Lowest Care Index was reported in patients
with acute, stressful life events (28.18%
(95% CI: 15.58-40.78) in the primary
dentition and 16.72% (95% CI: 8.59-24.85 )
in the permanent dentition) and with ADHDMedication (26.31% (95% CI: 13.98-38.64 )
in the primary dentition and 11.30% (95%
CI:4.40-18.20 ) in the permanent dentition).
Tab. 1 – Caries experience in the primary dentition of child and adolescent psychiatric patients
Code
All
F30-F39
(ICD-10)
F40-F48
(ICD-10)
F90-F98
(ICD-10)
1 - Axis 5
(DSM IV)
2 - Axis 5
(DSM IV)
4 - Axis 5
(DSM IV)
5 - Axis 5
(DSM IV)
6 - Axis 5
(DMS IV)
8 - Axis 5
(DSM IV)
Clinical disorders
N
patients
All
49
Affective Disorders
1
Neurotic, stress-related and somatoform
disorders
Behavioral and emotional disorders with onset
usually occurring in childhood and adolescence
18
47
Abnormal intrafamilial relations
15
Mental disorder, deviant behavior or disability in
the family
29
Abnormal educational conditions
34
Abnormal immediate surroundings
39
Acute, stressful life events
12
Chronic interpersonal stress associated with
school or work
3
Drugs
ADHD-Medication
17
Drugs
Antipsychotic medication
8
% Patients with
caries experience
(dmft>0)
(95% CI)
85.71
(75.91 - 95.51)
% Patients with
untreated caries
(d>0)
(95% CI)
69.39
(56.49 - 82.29)
/
/
94.44
(83.85 - 105.03)
85.11
(74.93 - 95.29)
80.00
(59.76 - 100.24)
89.66
(78.58 - 100.74)
85.29
(73.38 - 97.20)
89.74
(80.22 - 99.26)
100.00
(100.00 - 100.00)
88.89
(74.37 - 103.41)
68.09
(54.76 - 81.42)
66.67
(42.81 - 90.53)
68.97
(52.13 - 85.81)
61.76
(45.42 - 78.10)
74.36
(60.66 - 88.06)
83.33
(62.24 - 104.42)
/
/
88.24
(72.93 - 103.55)
75.00
(44.99 - 105.01)
76.47
(56.31 - 96.63)
50.00
(15.35 - 84.65)
dmft ± SD
dt ± SD
mt ± SD
ft ± SD
sic ± SD
3.63 ± 2.77
1.80 ± 1.97
0.59 ± 1.32
1.25 ± 1.74
6.81 ± 1.68
/
/
/
/
/
3.67 ± 2.40
2.06 ± 1.98
0.33 ± 0.59
1.28 ± 1.27
6.17 ± 1.94
3.62 ± 2.83
1.81 ± 2.01
0.60 ± 1.35
1.21 ± 1.79
6.81 ± 1.68
3.87 ± 3.04
1.80 ± 2.18
0.20 ± 0.41
1.87 ± 2.33
7.20 ± 1.92
3.69 ± 2.65
1.52 ± 1.72
0.79 ± 1.57
1.38 ± 1.90
6.70 ± 1.57
3.65 ± 2.83
1.50 ± 1.80
0.76 ± 1.54
1.38 ± 1.97
7.00 ± 1.55
3.82 ± 2.77
1.87 ± 2.04
0.67 ± 1.40
1.28 ± 1.81
6.92 ± 1.75
5.08 ± 2.71
3.42 ± 2.81
0.75 ± 1.29
0.92 ± 1.24
/
/
/
/
/
/
4.06 ± 3.01
2.65 ± 2.55
0.53 ± 0.94
0.88 ± 1.05
7.17 ± 2.23
3.63 ± 2.77
1.25 ± 1.83
1.00 ± 1.31
1.38 ± 1.85
/
Tab. 2 Caries experience in the permanent dentition of child and adolescent psychiatric patients
N
patients
% Patients with
caries experience
(DMFT>0)
(95% CI)
% Patients with
untreated caries
(D>0)
(95% CI)
DMFT ± SD
DT ± SD
MT ± SD
FT ± SD
SIC ± SD
All
81
60.49
(49.84 - 71.14)
56.79
(46.00 - 67.58)
2.32 ±2.79
1.77 ± 2.23
0.01 ± 0.11
0.54 ± 1.08
5.67 ± 2.18
F30-F39
(ICD-10)
Affective Disorders
5
80.00
(44.94 - 115.06)
80.00
(44.94 - 115.06)
2.80 ± 2.39
1.80 ± 1.30
0.00 ± 0.00
1.00 ± 1.41
/
F40-F48
(ICD-10)
Neurotic, stress-related and somatoform
disorders
30
66.67
(49.80 - 83.54)
66.67
(49.80 - 83.54)
3.40 ± 3.58
2.53 ± 2.84
0.03 ± 0.18
0.83 ± 1.34
7.70 ± 2.21
F90-F98
(ICD-10)
Behavioral and emotional disorders with onset
usually occurring in childhood and adolescence
70
57.14
(45.55- 68.73)
52.86
(41.17 - 64.55)
2.24 ± 2.80
1.67 ±2.21
0.01 ± 0.12
0.56 ± 1.12
5.61 ± 2.31
1 - Axis 5
Abnormal intrafamilial relations
(DSM IV)
26
46.15
(26.99 - 65.31)
46.15
(26.99 - 65.31)
2.15 ± 3.26
1.46 ± 2.21
0.04 ± 0.20
0.65 ± 1.32
5.89 ± 2.98
2 - Axis 5 Mental disorder, deviant behavior or disability in
(DSM IV) the family
46
52.17
(37.73 - 66.61)
50.00
(35.55 - 64.45)
2.15 ± 2.93
1.65 ±2.34
0.00 ± 0.00
0.50 ± 1.09
5.73 ± 2.46
47
57.45
(43.31 - 71.59)
55.32
(41.11 - 69.53)
2.38 ± 3.04
1.77 ± 2.29
0.02 ± 0.15
0.60 ± 1.19
5.88 ± 2.66
66
57.58
(45.66 - 69.50)
54.55
(42.54 - 66.56)
2.27 ± 2.93
1.79 ± 2.37
0.02 ± 0.12
0.47 ± 1.03
5.82 ± 2.38
6 - Axis 5
Acute, stressful life events
(DMS IV)
23
78.26
(61.40 - 95.12)
78.26
(61.40 - 95.12)
3.57 ± 3.52
2.65 ± 2.66
0.04 ± 0.21
0.97 ± 1.42
7.75 ± 2.12
8 - Axis 5 Chronic interpersonal stress associated with
(DSM IV) school or work
5
20.00
(-15.06- 55.06)
20.00
(-15.06 - 55.06)
1.20 ± 2.68
1.00 ±2.24
0.00 ± 0.00
0.20 ± 0.45
/
Code
All
Clinical disorders
4 - Axis 5
Abnormal educational conditions
(DSM IV)
5 - Axis 5
Abnormal immediate surroundings
(DSM IV)
Drugs
ADHD-Medication
21
42.86
(21.69 - 64.03)
42.86
(21.69 - 64.03)
1.19 ± 1.89
0.95 ± 1.47
0.00 ± 0.00
0.24 ± 0.70
3.29 ± 1.98
Drugs
Antipsychotic medication
14
50.00
(23.81 - 76.19)
42.86
(16.94 - 68.78)
1.57 ± 2.17
0.93 ± 1.59
0.00 ± 0.00
0.64 ± 1.28
/
Conclusion
High caries prevalence, DMFT/dmft and untreated caries was found in children and adolescents hospitalized with psychiatric disorders and psychosocial and
environmental problems.
Reference
* Pieper K. Epidemiologische Begleituntersuchungen zur Gruppenprophylaxe 2009. Gutachten. Deutsche Arbeitsgemeinschaft für Jugendzahnpflege, Bonn 2010
17.-19.09.2015 –20. Annual Meeting of EADPH, Istanbul, Turkey
[email protected]