Look Ma, No Cavities! Look Ma, No Cavities! Fact or Fiction? Fact - - PowerPoint PPT Presentation

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 1979-

• 1980 vs. 1988

1980 vs. 1988-

• 1994

1994

1 2 3 4 5 6 7 8 9 9 11 13 15 Age in Years Mean DMFS

Caries Decline Caries Decline 1988 1988-

• 1994 vs. 1999

1994 vs. 1999-

• 2002

2002

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

NHANES Selection of

individuals

Voluntary

participation

8-9 year olds

741 children

State data

BSS Selection of schools Combination of

positive and passive consent

3rd Grade

31 states 93,471 children

Percent of 3 Percent of 3rd

rd Graders

Graders with Caries Experience with Caries Experience

Source: NHANES IV, National Oral Health Surveillance System Caries experience in primary & permanent teeth

Percent of 3 Percent of 3rd

rd Graders

Graders with Untreated Decay with Untreated Decay

5 10 15 20 25 30 35 40 45 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

Percent of 3 Percent of 3rd

rd Graders

Graders with Dental Sealants with Dental Sealants

10 20 30 40 50 60 70 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

R2 = 0.4458

20 30 40 50 60 70 80 10 15 20 25 30 35 40 45 Untreated Decay Free/Reduced Lunch Percent

Source: USDA, National Oral Health Surveillance System

FRL & Caries Experience FRL & Caries Experience

R2 = 0.3326

20 30 40 50 60 70 80 30 40 50 60 70 80 Caries Experience Free/Reduced Lunch Percent

FRL & Dental Sealants FRL & Dental Sealants

R2 = 0.233

20 30 40 50 60 70 80 15 25 35 45 55 65 75 Dental Sealants Free/Reduced Lunch Percent

Look Ma, I Look Ma, I’ ’ve Got Cavities! ve Got Cavities!

Is the decline in caries

prevalence noted in national data

• ccurring nationwide?

Is it possible that caries

prevalence is on the rise in some states?

One State One State’ ’s Experience s Experience

10 20 30 40 50 60 70 1994 2000 2005 Percent with Decay Experience All Teeth Permanent Teeth Minority 2nd Grade Children

Permanent Dentition Only Permanent Dentition Only

5 10 15 20 25 30 Minority White Non-Hispanic Percent with Decay Experience 1994 2000 2005

2nd Grade Children

NHANES IV

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?