1. Complexity and the Future Elizabeth T Treasure Professor of Dental Public Health Cardiff University On behalf of the ADH Consortium

2. 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

3. Objectives Present the occurrence of restorative care in the population Describe the complexity of conditions with in the population and discuss risk factors

4. 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

5. 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

6. Restored teeth and surfaces as a percentage of natural teeth and surface by age

7. Dentures Almost 20% used dentures 6% edentate and used full dentures 13% dentures and natural teeth – Reducing since 1998 (19%)

8. Use of dentures by age

9. Mean number of restored, otherwise sound teeth by age, England 1978- 2009

10. 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

11. 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

12. 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 weve measured this)

13. 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

14. 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

15. Prevalence of complexity: individual conditions ConditionPercentage of adults Restored surfaces (top quintile)21 Crowns (highest quintile)16 Denture/bridge/implant20 One or more quadrant with 6mm+ pocket, 9mm+LoA 9 Active decay crown or root31 Active decay top quintile6 PUFA greater than 0 or unrestorable tooth 12 OHIP one or more fairly or very16

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

17. Dental health and complexity 3+

18. Dental Health and complexity 5+ by age

19. Complexity 4+

20. Complexity 5+

21. Estimated odds ratio for a complexity score of 5 or more Age**16-241 25-345.61* 35-447.45** 45-5419.44** 55-6422.77** 65+25.26** Pattern of dental attendance** Regular check up1 Occasional check up1.22 Only with trouble2.08** Never3.32**

22. Estimated Odds ratio for a complexity score of 5+ Frequency of teeth cleaning ** Twice or more1 Once a a day1.50* Never / less than once a day 3.27** Plaque**No plaque1 Has plaque1.99** Smoking status**Never smoked1 Ex-smoker0.84 Current smoker1.88**

23. 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

24. 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%