Elizabeth Treasure

adult dental health survey: Total tooth loss in the United Kingdom in 1998 and implications for the future

The 1998 Adult Dental Health Survey, published this year, showed that the number of people without teeth should fall over the next three decades, to only 4% of the UK population. Patterns of tooth loss and retention are also changing. This article, the first of a series on the interpretation of the Adult Dental Health Survey, discusses the implications of these trends for dentistry.

Adult Dental Health Survey 2009: transformations in British oral health 1968-2009

This series of four papers reports and interprets the findings of the Adult Dental Health Survey (ADHS), 2009, published in early 2011. This is the fifth in a series of surveys repeated every decade since 1968. The evolution of the surveys and the way the supporting methodology has changed to meet the changing needs and circumstances over the last 40 years is described. In 1968, 37% of adults in England and Wales were edentate. By 2009, only 6% of the combined population of England, Wales and Northern Ireland were edentate. Among the dentate in 1968, there were a mean of 21.9 teeth. By 2009, not only had the dentate increased by 30 percentage points as a fraction of the population, but the number of teeth in this group had also increased by nearly four teeth on average to 25.7. There were significant variations in oral health according to geography and social variables and smaller differences according to sex. The retention of 21 or more teeth is widely used as a way of defining a minimum functional dentition. The proportion of adults with 21+ teeth increased from 73% in 1978 to 86% in 2009. Further huge improvements are projected as younger generations age, assuming future tooth loss continues at current low rates. We might expect that over 90% of those aged 35-44 in 2009 have a realistic prospect of retaining a functional natural dentition of 21 or more teeth by age 80.

Factors associated with oral health: a multivariate analysis of results from the 1998 Adult Dental Health survey

This paper presents results from the 1998 Adult Dental Health Survey using multivariate analysis. This enables analysis of several variables at one time to see which are having an effect on peoples oral health. The paper compares these variables to a variety of outcome measures and makes recommendations for dental practice.

Adult Dental Health Survey 2009: implications of findings for clinical practice and oral health policy

This is the final paper in a series reporting on the results of the 2009 Adult Dental Health Survey. Since 1968 national adult surveys have been repeated every decade with broadly similar methods providing a unique overview of trends in oral health over a 40-year period. This paper aims to explore the implications for dentists and oral health policy of the key results from the Adult Dental Health Survey 2009. Although repeat, cross-sectional, epidemiological surveys provide very valuable data on trends in disease patterns, they do not provide answers to test causal relationships and therefore cannot identify the causes for the significant improvements in oral health over the last 40 years. Evidence would indicate, however, that broad societal shifts in population norms and behaviours, combined with changes in clinical diagnostic criteria, treatment planning and clinical procedures are the main reasons for the changes that have taken place. Key implications of the survey results include the need to monitor, support and maintain the good state of oral health of the increasing proportion of younger adults with relatively simple treatment needs. A smaller number of young and middle aged adults but a significant proportion of older adults will have far more complex treatment needs requiring advanced restorative and periodontal care. Future oral health policy will need to address oral health inequalities, encourage skill mix and promote and facilitate the dental profession to deliver appropriate and high quality care relevant to the needs of their local population.

The TREND Statement

Readers will be familiar with the CONSORT guidelines for the reporting of randomised controlled trials. These guidelines were designed to improve the reporting of RCTs and are of considerable use to researchers designing and reporting studies as well as to editors and to systematic reviewers. However, a major limitation of CONSORT is that they are limited to RCTs and there are far more research designs than RCTs. Some topics just cannot be investigated using RCTs and yet it may often be desirable to try to identify whether or not there is a causal link between two factors. It is therefore very welcome to see the development of the TREND statement (www.trend-statement.org/asp/trend.asp) — the Transparent Reporting of Evaluations with NonRandomised designs. As the authors state these guidelines are developing — there is room for alteration and improvement but their prime focus is to encourage the transparency or clarity of reporting. In view of the evolutionary state of these guidelines, I would encourage researchers, editors and reviewers to become familiar with them and to start using them. As they are used, areas, primarily of omission, will become apparent. The first area that needs expanding, in my opinion, is that more detail is required describing the characteristics of each population subgroup. I consider that more prominence of the potential for confounding factors needs to be acknowledged. As CONSORT has helped both investigators and reviewers improve the quality of RCTs and systematic reviews there is the possibility for TREND to do the same