Look Ma, No Cavities! Look Ma, No Cavities! Fact or Fiction? Fact or Fiction? Kathy Phipps, DrPH ASTDD Data Coordinator The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.
Look Ma, No Cavities Look Ma, No Cavities � 1958 Ad Campaign � Crest toothpaste � Mad Magazine � December 1958
Look Ma, No Cavities! Look Ma, No Cavities! 1979- -1980 vs. 1988 1980 vs. 1988- -1994 1994 1979 9 8 7 Mean DMFS 6 5 4 3 2 1 0 9 11 13 15 Age in Years
Caries Decline Caries Decline 1988- -1994 vs. 1999 1994 vs. 1999- -2002 2002 1988
Question of the Day Question of the Day Posed by State Health Director Posed by State Health Director E ver ything I r ead says that dec ay r ates ar e dec lining; so why is the pr evalenc e of tooth dec ay so high in my state?
National Compared to State Data National Compared to State Data
National & State Oral Health Data National & State Oral Health Data � National data � State data � NHANES � BSS � Selection of � Selection of schools individuals � Combination of � Voluntary positive and passive participation consent � 3 rd Grade � 8-9 year olds � 741 children � 31 states � 93,471 children
rd Graders Percent of 3 rd Graders Percent of 3 with Caries Experience with Caries Experience Source: NHANES IV, National Oral Health Surveillance System Caries experience in primary & permanent teeth
rd Graders Percent of 3 rd Graders Percent of 3 with Untreated Decay with Untreated Decay 45 40 35 30 25 20 15 10 5 0 VT ND NE WA ME NH OR UT MA MD CO MO GA ID PA KS AK CA DE IL SD WI SC NY KY NM NV MS AZ OK AR Source: NHANES IV, National Oral Health Surveillance System Untreated decay in primary & permanent teeth
rd Graders Percent of 3 rd Graders Percent of 3 with Dental Sealants with Dental Sealants 70 60 50 40 30 20 10 0 SC HI MD AR MS PA IL NY CA MO KY KS NV DE CO AZ OK GA NM NE NH WI ME SD UT WA OR AK ND ID MA VT Source: NHANES IV, National Oral Health Surveillance System Dental sealants on permanent molars
Look Ma, No Cavities! Look Ma, No Cavities! � Large variation in decay experience from state to state � Why does this variation exist?
FRL & Untreated Decay FRL & Untreated Decay 80 Free/Reduced Lunch Percent 70 60 50 R 2 = 0.4458 40 30 20 10 15 20 25 30 35 40 45 Untreated Decay Source: USDA, National Oral Health Surveillance System
FRL & Caries Experience FRL & Caries Experience 80 Free/Reduced Lunch Percent 70 60 50 40 R 2 = 0.3326 30 20 30 40 50 60 70 80 Caries Experience
FRL & Dental Sealants FRL & Dental Sealants 80 Free/Reduced Lunch Percent R 2 = 0.233 70 60 50 40 30 20 15 25 35 45 55 65 75 Dental Sealants
Look Ma, I’ ’ve Got Cavities! ve Got Cavities! Look Ma, I � Is the decline in caries prevalence noted in national data occurring nationwide? � Is it possible that caries prevalence is on the rise in some states?
One State’ ’s Experience s Experience One State Percent with Decay Experience 70 60 50 40 30 20 10 0 1994 2000 2005 All Teeth Permanent Teeth Minority 2 nd Grade Children
Permanent Dentition Only Permanent Dentition Only Percent with Decay Experience 30 25 NHANES IV 20 15 10 5 0 Minority White Non-Hispanic 1994 2000 2005 2 nd Grade Children
Why is Prevalence Increasing? Why is Prevalence Increasing? � Differences is sampling/survey design � Actual increase in caries … � Changing dietary patterns • Increasing sugar consumption • Decreasing water (fluoride) consumption � Treatment effect … � Dentists may be treating small lesions not previously treated
Treatment Effect Treatment Effect Fissurotomy Bur
Quote from Dental Economics Quote from Dental Economics … documented that well over 94% of the stains in pits and grooves of nonsmokers have undetected carious lesions. As dentists working in 2001, we need to use the science at our disposal. The amount of routine, "run-of-the-mill" dentistry that goes undiagnosed is probably enough to keep dentists as busy as they want to be. Hoos JC. How to profit from clinical and management methods for your practice. Dental Economics, October 2001.
Look Ma, No Cavities Look Ma, No Cavities Fact or Fiction? Fact or Fiction?
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