Please enable JavaScript.
Coggle requires JavaScript to display documents.
Epidemiology & Determinants (Surveillance & Monitoring (Define:…
Epidemiology & Determinants
OH of Older People
Define: Dental Transition
Edentulism rates have dropped in all ages groups (since 1950s)
= greastest decrease in older people in recent years
Oral Conditions affecting Old people:
tooth loss; dental caries
periodontal disease; dry mouth; oral cancer
Tooth Loss
Incremental (unplanned, symptom driven, >males)
edentulism (clinically determined, declining, >females)
Dental Caries
1 surface per year
(coronal 60%)(root 40%)
Periodontal Disease
most people have experiences (age accumulation)
disease only active in a minority (healthy survivor effect)
Dry Mouth
1/5 old people experience symptoms
polypharmacy
assoc. higher caries and reduced OHRQoL
OHRQoL = poorer in denture wearers + those w/ more missing teeth, decayed teeth, dry mouth, chewing issues
Enamel Defects
Relevance
aesthetic concerns - labeling behavior, stigma
aetiological aspects - perturbations during en. development & biological markers
Types
Opacities (no deficit in form/thickness)
Disruption to maturation phase
Demarcated / Diffuse
Hypoplastic (deficit in form/thickness)
Disruption to secretory phase
pits/grooves, partial/complete of enamel
Indices
:
Specific fluorosis indices - Deans Index
diagnosis, scored 2nd worst tooth, must show traits
Descriptive indices - Develop. Defects En. (DDE)
no diagnosis, scores three types of defects (demarcated/diffuse op., hypoplastic)
Risk Factors
Diffuse Op. = Fluoride exposure
Demarcated Op. = Caries experience
Hypoplasia = VSV before age 3, trauma, fever
Tx Need Measures
Why
workforce planning (health need approach)
guage effectivness of dental care system
Identify groups missing out/ neglected
Bradshaw's Taxonomy of Needs
perceived - comparative - expressed - normative
Types of Normative needs
incremental needs (yearly) - backlog (accumulative needs)
Issues w/ estimating Tx needs
Sampling sequence = making inferences about source popn from sample popn
<50% of NZ adults are routine users
Differences in people presenting and actual epidemiology/dental diagnosis
only clinical exams used (miss 40% lesions)
How
CPI data: simplistic but accurate guide to required needs
Ortho data: Index of Ortho Tx needs (clinical norms) Vs. Dental Aesthetic Index (social norms)
ex. LTRU
Accumulation of tx needs (&cost) increased for those that discontinued RU
LTRU associated with reduce tx needs/cost for tx
Perio Epi/Public
Challenges:
• The situation at a point in time is an ACCUMULATION of disease experience,
• There are many OBSERVATION sites,
• Difficult to DEFINE a case
Epi Facts:
NZOHS
Higher prevalence in males
Higher prevalence in Maori/Pacific Island
Higher prevalence in low SES(high deprivation)
DMHDS
Social disparity - low SES 2.3x more likely to develope PD cf. high SES
Prevalence and extent increased with age (ACCUMULATIVE)
Loe et al
only a specific group are susceptible to developing severe PD
Measurements
:
• Russel - no probe, observation
• CPITN - worst tooth per sec recorded and scored (WHO probe)
• CAL - attachment loss, MB/midB,DL (NIDR probe)
Data Collection
longitudinal studies
• Baseline/Incident measure - AL, plaque, calculus
• Progressive/over time - AL, plaque, calculus
prospective
x-sec studies
• Prevalence - % popn who are case
• Extent - % sites affected
• Severity - mean AL acrossed measure sites
snapshot
Risk Factors:
Smoking
Causally associated
Smoking has systemic effects (i.e vasoconstriction and masked bleeding)
Smokers, compared to non-smokers, are 2 to 8 times more likely to have PD
1/3 of all new cases can be attributed to smoking (Thompson et al, 2007)
prevalence, extent, & severity of CAL highest among current smokers, lowest in never
Diabetes
many positive and negative assoc.
believed that glycemic control, disease duration, and other factors are major impactors
Genetic Susceptibility
Loe et al = only a specific group are susceptible to developing severe PD
Mucosal Conditions
Why
Wide range of lesions
Severity & Risk for pt.
Some rare, some common
nb: 3.4 per 100,000
Methodological Aspects
Collection of data
Type(appearence), location, size
nb: accurate diagnosis difficult, so affects data validity
Recent NZ data: 17.3% had any lesion - no difference in sex, deprivation or ethnicity
Types of lesions
• Leukoplakia
• Erythroplakia
• Mucosal Hyperplasia
• Palatal Kertaosis
• Lichen Plannus
• Herpes labalis
• Candidasis
• Denture-Induced Lesions
• OSSC
OSSC Epidemiology
SCC is the most common and important
All types of tumors increasing in NZ - smoking related
Execpt women and salivary gland tumors
Birth cohort defects seen in males - early 1900s
Public Health Aspects
clinical vigilance is essential
Focus on reducing RF exposure
screen testing
NPV to be high = avoid missing those w/ disease
HUGE benefit for those who don't regularly attend
Dry Mouth
SGH
measurable, chronically low salivary flow rates
Sialometry - gravimetric/volumetric
Xerostomia
felt, symptoms of dry mouth
Symptoms need to be assessed
single Item approach
battery item approach
multi inventory approach
= 11[XI] items summate severity of chronic dry mouth symptoms (never--->very often)
- experimental symptoms
i.e dryness of mouth, taste impariment
- behavioral symptoms
i.e drinking frequently, sucking on sweets
Epi Facts:
NZOHS - "dry mouth" prevalence was 13.1% (higher in 25-34 & 75+)
DMHDS - "dry mouth" no sex difference @ age 32
Lots of variation in SGH prevalence, more so in defintions of condition
DRY MOUTH Medication: Anginals w/ no B-blocker OR Diuretics w/ thyroxine
HSR
Define HSR
:
Research focuses on answering questions related to "what should be happening in our healthcare system" and "what actually is happening"
Features of HSR
:
Multidisciplinary - theory and analytical
Multi-method approach - quantitative and qualitative ex. surveys, audits, observations, interviews
Ex. (i) Dentistry & Stress
Most common stressors are difficult children, time pressure, maintaing high conc.
Overseas/migrant dentists reported more frequent stress
Males complained of concentration, pain & children
Coping strategies differ by gender and graduating cohort
Ex. (ii) Tx of Frail Old
GPDs aware of edentulism rate and caries rate
Incorrectly thought root caries [40%] was higher, actually coronal is [60%] and that PD was a of major concern (i.e healthy survivor effect)
No. barriers preventing GPDs tx in nursing homes/LTCF
ex. (iii) Tx Children under GA
Increasing trends in the numbers treated and waiting tiems before tx (worsening)
Tooth Loss & Edentulism
Definition edentulism
: The state of having lost all natural teeth
Definition tooth loss
: The loss of one or more teeth short of complete edentulism
Determinants:
Socio-cultural (societal and professional norms)
Disease-related (caries, PD, trauma)
Rehabilitation reasons (prosthetic, orthodontics)
Epidemiological facts:
more common in females than males
most prevalent in highest age (75+) bracket
more common in low SES and Maori population
nb: Three Tiers of Influence
minor: anxiety, war, PD
major: rural isolation, patient decisions
universal: a lay culture of, poor dental utilisation
Surveillance & Monitoring
Define: Surveillance
Ongoing and systematic collection, analysis and interpretation of health data in the process of describing and monitoring a health event
e.g SDS
Define: Monitoring
Systematic collection, analysis, and interpretation of health data
e.g National OH survey
Difference
Surveillance is resource intensive and requires on-going data collection system
Monitoring is as funded, intermittent/sporadic
Why
Public health decisions should be made on the basis of information of presenting diseases
Uses
Estimating the magnitude of a health care problem
Detecting emerging problems/epidemics
Describing natural hx of disease
Monitoring changes in Risk Factors of condition
Ex. NZ SDS for Children Caries
Annual collection of data on dental caries (Year 8s & Age 5)
CWF was assoc. a reduction of dental caries in both age cohorts
High caries prevalence and mean DMFT caries in Maori/PI groups
Policy reforms disadvantaged households, increased OH inequalities