Complexity and the Future

Elizabeth T TreasureProfessor of Dental Public Health

Cardiff University

On behalf of the ADH Consortium

ADHS E,W, & NI: Collection of logos and

The NHS Information Centre and ONS worked in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of:

Adult Dental Health Survey 2009

–Birmingham

–Cardiff

–Dundee

–Newcastle

–University College London

Objectives

• Present the occurrence of restorative care in the population

• Describe the complexity of conditions with in the population and discuss risk factors

Fillings• 84% had at least one filled tooth• And - for those with a filling

– 7.2 teeth affected – 15.7 surfaces

• 26% had secondary decay or an unsound restoration

• 97% of those aged 45-54 years had at least one filled tooth

Fillings

• More teeth and more fillings in those who:– Report attending more frequently– Report attending more recently – Report more toothbrushing

– In Wales and Northern Ireland– With increasing age

– In manual occupational classes

Restored teeth and surfaces as a percentage of natural teeth and

surface by age

Dentures

• Almost 20% used dentures

• 6% edentate and used full dentures

• 13% dentures and natural teeth– Reducing since 1998 (19%)

Use of dentures by age

0%10%

20%30%

40%50%

60%70%

80%90%

100%

All 16-44 45-54 55-64 65-74 75+

Edentate no dentures

Edentate with dentures

Natural teeth anddenturesNatural teeth only

Mean number of restored, otherwise sound teeth by age, England 1978-

2009

0

2

4

6

8

10

12

All 16-24 25-34 35-44 45-54 55-64 65+

197819881998

Artificial Crowns

• 37% had at least one crown• 16-24 years 5%• 55-74 years 55% - 59%

• For those with crowns: average of 3 per person (similar to ’98)

• 47.6 million crowns across the three countries

Bridges

• 7% had a bridge

• 3% aged 16-44• 14% of those aged 55 to 74

• More common in regular attenders– Increasing use of bridges since ‘98

Implants

• 1% had an implant

• 0.5% of those aged 25 to 34 years

• 2% of those aged over 65

• 2% in intermediate occupations• 1% in professional and manual

– (First time we’ve measured this)

Development of complexity measure

• Some people have a single condition which requires ‘complex’ treatment

• Others have a number of conditions– On their own each condition may be ‘simple’– In combination they may be ‘complex’

• The data I will present is not a score but rather a count

Indicators of complexity

• Top quintile of restored surfaces (32+ restored)

• Top quintile for crowns (3 or more)

• Having any denture, crown

or implant• Having one or more sextant

with pocket of 6mm or more or LOA of 9mm or more

• Having any active decay of tooth or root

• Being in the top quintile for active decay (8 or more surfaces)

• PUFA score greater than 0 or an unrestorable tooth

• At least one OHIP indicator very or fairly often in last 12 months

Prevalence of complexity: individual conditions

Condition Percentage of adultsRestored surfaces (top quintile) 21

Crowns (highest quintile) 16

Denture/bridge/implant 20

One or more quadrant with 6mm+ pocket, 9mm+LoA

9

Active decay crown or root 31

Active decay top quintile 6

PUFA greater than 0 or unrestorable tooth

12

OHIP one or more fairly or very 16

Complexity in the population

• 37% had no measure of complexity

• 27% had one measure of complexity

• 19% had three or more measures– Approx. 7.7 million people

Dental health and complexity 3+

0%10%20%30%40%50%60%70%80%90%

100%

All 16-24

25-34

35-44

45-54

55-64

65-74

75+

EdentateDentate complex 3+Dentate not complexExcellent

Dental Health and complexity 5+ by age

0%10%20%30%40%50%60%70%80%90%

100%

All 16-24

25-34

35-44

45-54

55-64

65-74

75+

EdentateDentate very complexDentate not complexExcellent oral health

Complexity 4+

Complexity by age

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

9000000

10000000

16 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over

Age group

Complex

Dentate, not complex

Edentate

Complexity by age

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

9000000

10000000

16 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 and over

Age group

Complex

Dentate, not complex

Edentate

Complexity 5+

Estimated odds ratio for a complexity score of 5 or more

Age** 16-24 1

25-34 5.61*

35-44 7.45**

45-54 19.44**

55-64 22.77**

65+ 25.26**

Pattern of dental attendance**

Regular check up 1

Occasional check up 1.22

Only with trouble 2.08**

Never 3.32**

Estimated Odds ratio for a complexity score of 5+

Frequency of teeth cleaning **

Twice or more 1

Once a a day 1.50*

Never / less than once a day

3.27**

Plaque** No plaque 1

Has plaque 1.99**

Smoking status** Never smoked 1

Ex-smoker 0.84

Current smoker 1.88**

Factors associated with complexity

• Increasing age• Less frequent reporting of dental attendance• Less frequent reporting of tooth cleaning• Presence of plaque• Current smoker

– NB difference to fillings

Conclusions

• Restorations remain very common in all age groups

• There are changing patterns in the provision of restorations – Few dentures, more bridges and implants

• A method of combining complex conditions is presented

• Multiple conditions are present in approximately 20%