National Dental Epidemiology Programme and child caries data 3 October 2014 Nick Kendall Consultant in Dental Public Health PHE London Region

Dental Public Health Epidemiology Programme (England) 2

3 Healthcare reforms and transition of the dental epidemiology programme in England

Dental Public Health Epidemiology Programme Handover of the NHS Dental Epidemiology Programme from Dept. Health & NHS to PHE 1 st April 2013 Change in legislation and guidance Dental Public Health functions of Local Authorities Public Health Outcomes Framework – 5 yr olds Regular monitoring fluoridation Required Programme review and reform 4

Overall Programme structure PHE Dental Public Health Intelligence Programme Oversight Group Strategy Group of stakeholders Operational Group(s) Knowledge and Intelligence Team North West Dental Public Health Epidemiology Team Dental Public Health Consultants in PHE Centres NHS EnglandLocal Authorities Salaried Dental Service staff in NHS and CIC fieldwork Dental Epidemiology Trainer & Standard Examiner network Dental Epidemiology Coordinator network Multiple workstreams Information Governance

Programme outputs 6 net/dentalhealth/

Programme outputs 7

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Measuring dental caries / tooth decay

Measurement of oral disease and conditions Dental caries - dmf/DMF Gingivitis - Silness and Löe Oral hygiene, stain, calculus - WHO Periodontal disease - CPITN Orthodontic - IOTN Tooth wear/erosion - Walker et. al. Dental trauma - O’Brien Developmental defects (DDE) - Clarkson and O’Mullane 11

Measuring dental caries DMFT/dmft Index (Klein et al., 1938) Disease and treatment index Decayed teeth / Missing teeth / Filled teeth Diagnostic criteria (threshold caries diagnosed) in dental surveys no x-rays sharp probe 0.5 mm break in enamel visual lesion into dentine International Caries Detection and Assessment System (ICDAS) 12

Diagnostic criteria used in surveys Caries Decayed Missing and Filled Index Caries (code 2) - ‘surfaces are recorded in this category if, in the opinion of the trained examiner, after visual inspection, there is a carious cavity into dentine’. BASCD core caries criteria 13

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lesions into the pulp small lesions detectable only with additional diagnostic aids sub-clinical initial lesions in a dynamic state of progression / regression The Varying Stages of Tooth Decay Extensive decay Moderate decay Initial decay very early stage decay clinically detectable lesions in dentine clinically detectable ‘cavities’ limited to enamel clinically detectable enamel lesions with ‘intact’ surfaces + hidden decay (in dentine and in enamel) not seen by visual inspection Obvious Decay as assessed in NHS DEP / BASCD examinations

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Measuring dental caries Severity of disease population mean DMF/dmf DMF/dmf teeth or surfaces Prevalence of caries experience proportion with lifetimes caries experience ie: those with DMF of 1 or more (% DMF > 0) D/d gives indication untreated disease (% D/d > 0) normative need 19

Measuring dental caries Care Index - response to caries in restorative care CI% = F/DMF X 100 : f/dmf X 100 Treatment Index – total treatment response TI% = [F+M]/DMF X 100 : [f+m]/dmf X 100 Adult studies - DMF Missing - may not be to caries total tooth loss (edentulous cohort) 20

Measuring dental caries Children studies - dmf and DMF mixed dentition exfoliating deciduous teeth age groups - pre-school; 5; 12; 14 Positive consent for surveys England and wales Comparability 21

Measuring dental caries in a child population - dmft

Study 5yr olds in a London Borough 23

Study 5yr olds – n=430 24

Study 5yr olds London Borough 25

Study 5yr olds London Borough 26

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Contact 28