N M Nuttall

Dental attendance in 1998 and implications for the future.

The 1998 survey of Adult Dental Health in the UK was carried out under the auspices of the Office of National Statistics together with the Universities of Birmingham, Dundee, Newcastle-upon-Tyne and Wales. A key behavioural indicator in these decennial surveys is whether people say they go to a dentist for a regular dental check-up, an occasional dental check-up or only when they have trouble with their teeth. The proportion of dentate adults in the UK who report attending for regular dental check-ups has risen from 43% in 1978 to 59% in 1998. Older adults (over 55 years old) in 1998 were the most likely to say they attend for regular dental check-ups. Many younger adults (16-24) in 1998 said they went to a dentist less often than 5 years previously, they were also the least likely to say they attend for regular dental check-ups. Dental anxiety remains a problem for many dental patients but another factor of importance to many is their want to be involved in the treatment process and especially to be given an estimate of treatment costs.

Restorative treatment thresholds reported to be used by dentists in Scotland

A questionnaire was sent by post to all dentists practising in the General Dental Service and the Community Dental Service in Scotland; 72% of them (1127) completed and returned it. Three sets of descriptions of carious lesions, ordered on the basis of increasing degree of severity, were supplied. One was based on the radiographic appearance of lesions affecting approximal surfaces, the others on the visual/tactile appearance of lesions affecting free smooth surfaces (buccal and lingual) and occlusal surfaces. For each type of surface the dentists were asked which description indicated the minimum point at which a filling ought to be provided (restorative treatment threshold) in 12- and 30-year-old patients. Overall, the majority of dentists said they would intervene earlier in the case of a 12-year-old than in the case of a 30-year-old patient. Many dentists indicated they would fill an approximal lesion whose radiolucency was confined to the enamel (44.2% for a 12-year-old, 20.1% for a 30-year-old). A further substantial proportion gave a response which suggested that the amelodentinal junction would be the critical decision point (25.8% for a 12-year-old, 19.3% for a 30-year-old). Many also felt that a filling ought to be provided prior to visible cavitation for lesions of the occlusal surfaces (55.1% for a 12-year-old, 22.1% for a 30-year-old); fewer advocated the same treatment threshold for lesions affecting buccal/lingual surfaces (24.1% for a 12-year-old, 9.2% for a 30-year-old).(ABSTRACT TRUNCATED AT 250 WORDS)

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.

A cross-national comparison of income gradients in oral health quality-of-life in four welfare states: application of the Korpi and Palme typology

Background: The extent to which welfare states may influence health outcomes has not been explored. It was hypothesised that policies which target the poor are associated with greater income inequality in oral health quality of life than those that provide earnings-related benefits to all citizens. Methods: Data were from nationally representative surveys in the UK (n = 4064), Finland (n = 5078), Germany (n = 1454) and Australia (n = 2292) conducted from 1998 to 2002. The typology of Korpi and Palme classifies these countries into four different welfare states. In each survey, subjects completed the Oral Health Impact Profile (OHIP-14) questionnaire, which evaluates the adverse consequence of dental conditions on quality of life. For each country, survey estimation commands were used to create linear regression models that estimated the slope of the gradient between four quartiles of income and OHIP-14 severity scores. Parameter estimates for income gradients were contrasted across countries using Wald χ2 tests specifying a critical p value of 0.008, equivalent to a Bonferroni correction of p<0.05 for the six pairwise tests. Results: Statistically significant income gradients in OHIP-14 severity scores were found in all countries except Germany. A global test confirmed significant cross-national differences in the magnitude of income gradients. In Australia, where a flat rate of benefits targeted the poor, the mean OHIP-14 severity score reduced by 1.7 units (95% CI −2.15 to −1.34) with each increasing quartile of household income, a significantly steeper gradient than in other countries. Conclusion: The coverage and generosity of welfare state benefits appear to influence levels of inequality in population oral health quality of life.

Adult dental health survey: Dental attendance in 1998 and implications for the future

The 1998 survey of Adult Dental Health in the UK was carried out under the auspices of the Office of National Statistics together with the Universities of Birmingham, Dundee, Newcastle-upon-Tyne and Wales. A key behavioural indicator in these decennial surveys is whether people say they go to a dentist for a regular dental check-up, an occasional dental check-up or only when they have trouble with their teeth. The proportion of dentate adults in the UK who report attending for regular dental check-ups has risen from 43% in 1978 to 59% in 1998. Older adults (over 55 years old) in 1998 were the most likely to say they attend for regular dental check-ups. Many younger adults (16–24) in 1998 said they went to a dentist less often than 5 years previously, they were also the least likely to say they attend for regular dental check-ups. Dental anxiety remains a problem for many dental patients but another factor of importance to many is their want to be involved in the treatment process and especially to be given an estimate of treatment costs.

periodontology: Self-reporting of periodontal health status

Objective The objective was to develop a self-reporting questionnaire for use as an epidemiological measure of periodontal status.Design Oral survey.Subjects and methods 100 (out of 102 who were approached) non-referred patients attending Dundee Dental Hospital and School agreed to complete a questionnaire concerning factors related to periodontal disease and then undergo a standardised periodontal examination in which four indicators were measured: the percentage of sites with plaque, the percentage of sites which showed bleeding on probing, tooth mobility and Community Index of Periodontal Treatment Needs scores.Main outcome measure Sensitivity and specificity of questionnaire items to predict clinically measured periodontal disease indicators. Acceptable levels for sensitivity and specificity are largely dependent on the context of the test being evaluated, and many tests currently used in dentistry have very low sensitivity or specificity values. Nevertheless, in this case it was felt that any items which had a sensitivity and specificity greater than 0.80 would be reasonable predictors.Results Only four items were weakly predictive of the periodontal status indicators (sensitivity and specificity > 0.5). These concerned noticing gaps between teeth getting bigger, noticing tooth roots becoming more visible, experiencing pain when consuming hot, cold or sweet things and smoking. Other items, concerned with whether a dentist had told the patient they had periodontal disease or whether the person was aware of being treated for it, had very low sensitivities suggesting that people with periodontal disease indicators are failing to be informed of, or treated for it, by their dentist.Conclusions Self-reporting of periodontal health was not successful as many people who had some indications of the periodontal diseases appeared to be unaware of their condition and also appeared not to have been informed nor were being treated for it.

The reported impact of oral condition on children in the United Kingdom, 2003

Background The 2003 Childrens Dental Health Survey is the fourth in a series of decennial national childrens dental health surveys of the United Kingdom.Aims This paper is concerned with how children are reported to have been affected by their oral condition during the 12 month period immediately preceding the survey and how this relates to the childrens experience of caries, their dental attendance behaviour and their social class.Method The information was gathered by self-completion questionnaire distributed to the parents of half of the sample who were clinically examined in the dental survey.Results Some form of impact was reported by the parents of 22% of five-year-olds, 26% of eight-year-olds, 34% of 12-year-olds and 28% of 15-year-olds. The pattern of responses to the eight impact questions was broadly similar across age groups. The most frequently reported type of impact was pain in all age groups. Impacts on oral function, self-confidence, orally related activity and on the childs emotions were experienced by 4-10% of children of all ages. Fewer children (1-2%) were reported to have experienced more far reaching impacts affecting their social functioning, general health and life overall.Conclusions Most children were reported not to have experienced any of the problems covered by the questionnaire. Of those who did, most reported a single problem and for most this was pain. Nevertheless there was a group of children for whom oral function, self-confidence, orally related activity, emotions, social functioning, their health or their life in general were reported to have been affected by their oral condition. The nature of dental care which is appropriate for such children needs to be determined.

Children's dental anxiety in the United Kingdom in 2003

BACKGROUND The prevalence of dental anxiety among a representative sample of children in the UK was determined in the Childrens Dental Health survey of 2003. AIMS This paper is concerned with the extent to which children in the United Kingdom are judged by a parent or carer to be behaviourally affected by dental anxiety and the factors associated with this. METHOD The information was gathered by self-completion questionnaire distributed to the parents of half of the sample of children who were also clinically examined in the dental survey. RESULTS Dental anxiety that was sufficient to disrupt dental attendance was reported for around 3-4% of the four age groups surveyed (5, 8, 12 and 15 years of age). Childrens dental anxiety was associated with parental dental anxiety; a greater experience of invasive dental treatment and general anaesthetic; receipt of free school meals and social class. CONCLUSIONS Whilst these findings do not necessarily indicate causal relationships, they do confirm a number of co-factors associated with dental anxiety perhaps most importantly that of anxiety with the experience of general anaesthetic for tooth extractions.

The Effect of Placing a Clear Pit and Fissure Sealant on the Validity and Reproducibility of Occlusal Caries Diagnosis

The purpose of this in vitro study was to assess the validity and reproducibility of the diagnosis of fissure caries prior to and following the placement of a clear sealant. One hundred and twelve extracted molar teeth were examined by 7 experienced clinicians. Each examiner conducted four visual examinations, 2 prior to and 2 after sealing, allowing an assessment of reproducibility. The teeth were subsequently serially sectioned to provide the histological validation. After placement of a sealant, a significant (p < 0.05) loss of sensitivity was found for the diagnosis of enamel lesions and dentine lesions, but specificity was not altered. The overall reproducibility expressed by the kappa statistic was 0.60 and 0.47, before and after sealing, respectively. The examiners significantly (p < 0.001) underestimated the severity of lesions detected after sealing compared to their assessment prior to sealing. The investigation suggests that sealed surfaces require careful assessment and monitoring.

Clinical decision making--an art or a science? Part V: Patient preferences and their influence on decision making

Part IV of this series introduced the idea that the value a patient places on an outcome has an important influence on the decision making process. This article considers this concept further. It argues that dentists should assess a patients preferences and consider these before deciding on a treatment option. The article explains that by enumerating all the treatment options and possible outcomes, it is possible to assess the value placed on each result. Similarly an assessment is crucial if the dentist aims to achieve the optimum treatment result--one which is regarded as the most favourable outcome by the patient