Based on Community Oral Health (Pine ) Essential Dental Public - - PowerPoint PPT Presentation

Based on Community Oral Health (Pine ) Essential Dental Public Health(Daly)

By

• Dr. Asgari

&

• Dr. Soheilipour

Overview

 About WHO  Burden of Oral Diseases  Epidemiology of dental caries

 Definition  Distribution

 By geography, age, gender, race/ethnicity, SES

 Determinants

 Food cariogenicity, diet

 Prevalence and extent of Oral Diseases in Iran  Conclusions

Learning Objectives

At the conclusion of this module, the participant will be able to:

 Define epidemiology  Define dental caries  Describe the dental caries index  Describe the epidemiology of dental caries  Describe factors related to dental caries

About World Health Organisation (WHO)

 The World Health Organization (WHO) is a

specialized agency that is concerned with international public health. It was established on 7 April 1948, with headquarters in Geneva, Switzerland.

 It is responsible for:  providing leadership on global health matters  shaping the health research agenda setting norms and standards  articulating evidence‐based policy options providing technical support to countries  monitoring and assessing health trends

WHO regional offices

WHO African Region WHO Western Pacific Region WHO South-East Asian Region WHO Region of the Americans WHO European Region WHO eastern Mediterranean Region

Policy Basis for the WHO Oral Health Programme

 Oral health is integral and essential to general

health

 Oral health is a determinant factor for quality of

life

 Oral health ‐ general health  Proper oral health care reduces premature

mortality

Oral health is integral and essential to general health

Oral health means more than good teeth; it is integral to general health and essential for well‐being. It implies being free of:

 chronic oro‐facial pain  oral and pharyngeal (throat) cancer  oral tissue lesions  birth defects such as cleft lip and palate, and  other diseases and disorders that affect the oral, dental and

craniofacial tissues, collectively known as the craniofacial complex. The World Oral Health Report 2003

 Dental caries and periodontal diseases and oral and

pharyngeal cancers have historically been considered the most important global oral health problems in both industrialized and increasingly in developing countries.

 In many developing countries, access to oral health

services is limited and teeth are often left untreated or are extracted because of pain or discomfort.

 Throughout the world, losing teeth is still seen by

many people as a natural consequence of ageing.

What is the burden of oral disease?

World Health Organization Report

What is the burden of oral disease?

 The impact of oral diseases in pain, suffering, impaired

function and reduced quality of life, is both extensive and expensive.

 Treatment is estimated to account for between 5‐10% of

health costs in industrialized countries, and is beyond the resources of many developing countries.

 Traditional treatment of oral disease is extremely costly,

the fourth most expensive disease to treat in most industrialized countries. In many low‐income countries, if treatment were available, the costs of dental caries alone in children would exceed the total health care budget for children.

World Health Organization Report

Dental Caries

 Epidemiology

The orderly study of diseases and other condition in human population where the group rather than the individual is the unit of interest and their causes or influences in well‐defined populations. Epidemiology is the study of the

 Distribution and  Determinants of  Disease/health in a population

 DMF index (permanent teeth) : The number of

Decayed, Missing and Filled Teeth (DMFT) or Surfaces (DMFS)

 Def, df indices (Deciduous teeth)

How to count dental caries for a population?

Human Teeth with Dental Caries

Dental enamel caries Dental enamel demineralization

Medical university of south Calorina/SC Geriatric Education Centre

Close-up Photograph of Root Caries

Dental enamel Root surface Root caries

Medical university of south Calorina/SC Geriatric Education Centre

Brief History of Dental Caries9

 Throughout most of 1900’s

 Dental caries experience

 seen primarily in high‐income countries  low prevalence in low‐income world  likely related to diet

 Late 1900’s

 Dental caries experience

 increase in some (not all) low‐income countries  decrease in high‐income countries among

 children  young adults

Medical university of south Calorina/SC Geriatric Education Centre

Distribution: Dental Caries

 Geographic  Age  Gender  Race / ethnicity  Socioeconomic status  Familial patterns

Medical university of south Calorina/SC Geriatric Education Centre

International Prevalence of Dental Caries

 Dental caries is still a major oral health problem in

most industrialized countries, affecting 60‐90% of schoolchildren and the vast majority of adults.

The World Oral Health Report 2003

International Prevalence of Dental Caries

 Dental caries is still a major oral health problem in

most industrialized countries, affecting 60‐90% of schoolchildren and the vast majority of adults.

 It is also a most prevalent oral disease in several Asian

and Latin American countries, while it appears to be less common and less severe in most African countries.

The World Oral Health Report 2003

International Prevalence of Dental Caries

 Dental caries is still a major oral health problem in most

industrialized countries, affecting 60‐90% of schoolchildren and the vast majority of adults.

 It is also a most prevalent oral disease in several Asian and

Latin American countries, while it appears to be less common and less severe in most African countries.

 In light of changing living conditions, however, it is

expected that the incidence of dental caries will increase in many developing countries in Africa, particularly as a result

• f a growing consumption of sugars and inadequate

exposure to fluorides.

The World Oral Health Report 2003

International Prevalence of Dental Caries

 Traditional treatment of oral disease is extremely

costly, the fourth most expensive disease to treat in most industrialized countries. In many low‐income countries, if treatment were available, the costs of dental caries alone in children would exceed the total health care budget for children

The World Oral Health Report 2003

DMFT WHO Regions

2011 2004

1.19 1.15 AFRO 2.35 2.76 AMRO 1.63 1.58 EMRO 1.95 2.57 EURO 1.87 1.12 SEARO 1.39 1.48 WPRO 1.67 1.61 Global

WHO Region specific weighted DMFT among 12‐yar‐olds

(Global weighted DMFT= (∑{DMFTi x Populationi}) / Total) // countriesalphab.html#Top http:www.whocollab.od.mah.se/ Malmo University , Oral Health Database

Year Publication Global DMFT

1985

Leclercq et al, 1987

2.43 1981

Leclercq et al, 1987

2.78 2001

CAPP (www.mah.se/capp)

1.74 2004

Bratthall, 2005

1.61 2011

Natarajan, 2011

1.67

Global DMFT for 12-year-olds - trends

// countriesalphab.html#Top http:www.whocollab.od.mah.se/ , Malmo University Oral Health Database

Dental caries levels (DMFT) of 12‐year‐olds worldwide (July 2003)

Dental caries levels (DMFT) of 35‐44‐year‐olds worldwide (July 2003)

Changing levels of dental caries experience (DMFT) among 12‐year‐olds in developed and developing countries

Oral Health trends in the UK…..

Oral Health trends in the UK…..

Frequency distribution of dental caries according to various tooth location

permanent dentition

Deciduous dentition

Distribution of dental caries according to tooth surface

 Occlusal > interproximal >buccal

Distribution: Age

 DMF scores increase with increasing age

 DMF index is cumulative

 (Decayed can become Filled, and then Missing through time)

 Whole tooth missing due to dental caries is equal to a count

• f 4 or 5 surfaces in the DMFS index

 Cohort effect

Distribution: Gender

 Females generally have higher DMF scores

 Probable treatment effect

 females usually have higher “Filled” component

 Earlier tooth eruption among females  Cannot say females are more susceptible to dental

caries

Distribution: Race‐Ethnicity

 Little evidence for inherent differences in dental

caries susceptibility across race‐ethnicity.

 Differences in socioeconomic status associated with

race‐ethnicity in the U.S. are probably more important.

Distribution: Socioeconomic Status

 SES relates to a person’s background‐values

 Education  Income  Occupation

 Most recent data suggest that DMFS scores are

inversely related to SES

Distribution : Familial Patterns9

 “My family has bad teeth”

May be a function of

 Bacterial transmission  Family habits/ culture

 diet  behavioral traits

 Genetics (e.g., salivary flow, composition)

 Additional research is needed

The trend in dental caries

 Whilst caries level have declined in developed countries in the

past 20 years there continues to be a large ‘at risk’ group for whom caries remains a major problem.

 Perhaps the most widely reported ‘at risk’ group are those in the

lower socio economic groups.

 This groups tend to:

 Bottle feed their babies  Wean them earlier  Use infant feeding bottles longer  Give babies fruit juice more regularly

And

 Parents have More social and financial problems  Their children have poorer school attendance records  Greater consumption of confectionary after school

Oral Health trends in Iran

The epidemiological surveys in Iran is relatively weak and regular regional and national oral health surveys have not been carried out.

 An assignment report1959-1989 12 year‐old children

(Leous 1993) 0.5 1 1.5 2 2.5 3 3.5 4 4.5 1959 1989 DMFT

Oral Health trends in Iran

The epidemiological surveys in Iran is relatively weak and regular regional and national oral health surveys have not been carried out.

 An assignment report1959-1989 12 year‐old children  The first nationwide survey1990-1992 6-69 year‐olds

Oral health in Iran, Hamid Reza Pakshir; International Dental Journal (2004)

The first nationwide survey conducted in 1990-1992 on a total of 34,985 children and adults aged 6-69

Caries free 88.6 % 31.3% 12.7% 1.2%

Oral Health trends in Iran

The epidemiological surveys in Iran is relatively weak and regular regional and national oral health surveys have not been carried out.

 An assignment report1959-1989 12 year‐old children  The first nationwide survey1990-1992 6-69 year‐olds  The second survey1995 12 year‐old children

 DMFT= 2.02  Caries free= 17 %  The major part in DMFT= D  The most carious teeth= first permanent molar

Oral health in Iran, Hamid Reza Pakshir; International Dental Journal (2004)

Oral Health trends in Iran

The epidemiological surveys in Iran is relatively weak and regular regional and national oral health surveys have not been carried out.

 An assignment report1959-1989 12 year‐old children  The first nationwide survey1990-1992 6-69 year‐olds  The second survey1995 12 year‐old children  The third survey 1998-1999

Oral health in Iran, Hamid Reza Pakshir; International Dental Journal (2004)

The d/D component in all age group had a major contribution to total caries experience and more than 80%of both primary and permanent dentition compromised decayed teeth

DMFT at 12‐year‐olds in Iran 1988–1998

0.5 1 1.5 2 2.5 3 3.5 4 4.5 1988 1992 1995 1998 DMFT

Oral Health trends in Iran

The epidemiological surveys in Iran is relatively weak and regular regional and national oral health surveys have not been carried out.

 An assignment report1959-1989 /12 year‐old children  The first nationwide survey1990-1992 / 6-69 year‐

• lds

 The second survey1995 / 12 year‐old children  The third survey 1998-1999/ 3, 6,9 & 12 year‐olds  The most recent survey 2004/ 3, 6,9 & 12 year‐olds

Oral health in Iran, Hamid Reza Pakshir; International Dental Journal (2004)

Mean DMFT/dmft index of children aged 3, 6, 9 and 12 years by sex and area of residence in Islamic Republic

• f Iran

Caries free % Mean dmft Mean DMFT

• No. sampled

Age group (years) 48 1.9

• 750

3 11 5.0 0.2 8725 6 10 3.6 0.9 8723 9 32

• 1.9

748 12

The mean caries experience (DMF‐T) according to age and location in 2001–2002

Total (n=8101) Rural (n=3669) Urban (n=5133) 15–19 years 2.75 0.84 0.61 4.1 3 0.78 0.22 4 2.5 0.7 1 4.2 DT MT FT DMFT (n=8741) (n=3619) (n=5122) 35–44 years 2 10.51 2 14.8 2.7 11.4 0.73 14.83 2.3 9.9 2.8 14.7 DT MT FT DMFT Oral Health Survey in 15‐19 and 35‐44 year‐olds in the Islamic Republic of Iran, 2001 ‐2002

Changes in caries diagnosis and measurement

 A problem: different types of carious lesions are

detected at varying diagnostic thresholds.

 As the open cavitation has become a rarity  The epidemiological criteria had to be changed to

reflect this change (like D3 to D1 scoring or ICDAS)

Oral Health trends in Iran

 In 2005 Mean value of the index of DMFT the 15‐

year‐olds was 2.1 .

(Yazdani et al 2008)

 In 2005 of a random sample of 459 third‐year primary

school children in the 16 schools in Tehran, The mean dmft value was 4.2 (SD+2.9) in boys and 3.4 (SD+2.6) in girls for the whole study group.

 The children of the low education parents had more

dental caries than those of high education parents in both primary and in permanent teeth.

(Saied‐moallemi 2006)

Prevention of Dental caries

 Whole population strategies

 Water fluoridation (the most effective and cost effective)  Oral health Education:

 Reduce the frequency of intake of foods and drinks sweetened

with sugar

 Brush teeth regularly with fluoride toothpaste  Visit a dental profession regularly

 ‘High risk’ strategies

 Fissure sealing

 Combination of whole and risk strategies