Adult Dental Health Survey 2009So does it matter? Impacts

Georgios Tsakos

On behalf of the ADHS consortium

Key questions

What do people think about their oral health?

What impact do oral conditions have on the quality of life of people? How many people are concerned?

How big a concern?

Which are the main problems that lead to impacts?

Which factors relate to these impacts?

Outline

Focus on subjective perceptions – main data source: interviewer-

administered questionnaire Outcomes:

1. Self-rated healtho General healtho Dental health

2. “Oral Health Related Quality of Life”o Oral health Impact Profile (OHIP-14) -

frequencyo Oral Impacts on Daily Performances

(OIDP) - severity

Variation by– Demographics– Socioeconomic position– Clinical dental status

Self-rated health

High levels of reported good or very good health: – 80% for general health and 71% for oral health, but… – Considerable minority with “fair/bad/very bad” dental health

Dental health ratings not affected by being edentate (adaptation? expectations?)… … but general health ratings are: broader importance of good dental health

Self-rated health by dental status

Worse dental health perceptions for people that have some natural teeth and also denture(s)

This is a group that is going to be very common in future cohorts of older people: public health concern?

Self-rated health by Occupation

Clear gradient in self-rated health (both general and dental) by socioeconomic classification of household among dentate people:

– Better perceptions (higher proportion with “good” or “very good” ratings) for each higher socioeconomic position (SEP) group

“Oral health related quality of life” measures: why use them?

Beyond clinical measures … into perceptions about how dental health affects quality of life

Measures of the extent that health status and conditions disrupt normal social-role functioning and bring about major changes in behaviour (Locker, 1989)

Subjective indicators that provide information on the impact of oral conditions on daily life of people

“OHRQoL” measures complement (not substitute) clinical measures

“Oral health related quality of life” measures

Oral Health Impact Profile - 14 (OHIP-14)

•14 items - 7 dimensions– Functional limitation– Physical pain– Psychological discomfort– Physical disability– Psychological disability– Social disability– Handicap

Oral Impacts on Daily Performances (OIDP)

•9 activities of daily living– Eating– Speaking– Cleaning teeth or dentures– Going out– Relaxing– Smiling– Carrying out major work or role– Emotional instability– Enjoying social contacts

“Oral health related quality of life” measures

Oral Health Impact Profile - 14 (OHIP-14)

•Frequency– In the last 12 months, have you had

trouble PRONOUNCING ANY WORDS because of problems with your teeth, mouth or dentures?

(1) ....never (2) ....hardly ever (3) ....occasionally

(4) ....fairly often (5) .... very often

•Prevalence, number of problems, OHIP-14 score

Oral Impacts on Daily Performances (OIDP)

•Severity– Using a scale from 0 to 5, where 0 is no

effect and 5 is a very severe effect, can you tell us what effect DIFFICULTIES EATING caused by your mouth, teeth or false teeth have had on your daily life in the past 12 months?

•Perceived causes– Which, if any, of the following have

caused DIFFICULTIES EATING?Toothache, Loose tooth, Bad position of teeth, Broken / fractured tooth, …

•Prevalence, extent, OIDP score

OHIP-14 dimensions Percentage experiencing problem occasionally or more often…

Dentate EdentateFunctional limitation 6 12Physical pain 30 33Psychological discomfort 20 15Physical disability 8 12Psychological disability 14 10Social disability 6 3Handicap 4 6At least one problem 39 40Mean number of problems 1.2 1.1Mean total OHIP-14 score 17.4 17.4

Frequency of impacts (OHIP-14)

Considerable proportion with impacts (39% of dentate and 40% of edentate) No difference in OHIP-14 between dentate and edentate people Most common impacts: physical pain and psychological discomfort Not very frequent, not many problems reported

Trends in impacts (OHIP-14) among dentate in England

Along with improvement in health, lower levels of oral impacts 51% had experienced impacts occasionally or more often in 1998 and 39% did so

in 2009

Severity of impacts (OIDP)

0

5

10

15

20

25

30

35

Eating Smiling Cleaningteeth

Relaxing Speaking Emotionalinstability

Enjoyingcontact

Working Going out At least oneoral impact

Percentage

Dentate

Edentate

One third of adults with impacts (33% of dentate and 29% of edentate) Most prevalent impacts: eating and smiling No difference between dentate and edentate people overall, but for specific

performances: dentate reported higher prevalence for smiling, cleaning teeth, and relaxing, while edentate had more impacts in relation to speaking

Severity of impacts - a closer look

• In general, impacts did not have severe effects on the daily life of participants…

• But 15% of dentate and 13% of edentate adults in the general population reported that their dental health had severe negative impacts on their daily life (OIDP rating > 3)

• Among those that reported at least one oral impact, almost half (46%) reported a score of 3 or higher in the OIDP severity ratings

• A minority with severe impacts: Who are they? What are their characteristics?

Impacts by dental status

Worse quality of life (higher proportion with impacts) for dentate people that have some natural teeth and also denture(s)

This is a group that is going to be very common in future cohorts of older people: public health concern?

Prevalence of impacts by Occupation among dentate

Socioeconomic position gradient , with worse quality of life at successively lower levels of household occupation among dentate people

Gradient is steeper for more severe impacts Lower socioeconomic position groups at disadvantage

Dentate adults: Clinical oral health Percentage with oral impactsOHIP-14 OIDP

Number of teeth

21 or more 39 34

Fewer than 21 52 45

Number of sound, untreated teeth

18 or more 36 32

Fewer than 18 46 40

Number of decayed teeth

None 38 33

One or more 49 42

Periodontal condition

No pockets of 4mm or more 37 33

Pockets of 4mm or more 45 38Excellent oral health (21+ teeth and 18+ sound and untreated teeth, no active decay, no 4mm+ pocketing or attachment loss)

Yes 34 32

No 42 36

Impacts by clinical status

Impacts were associated with every clinical measure among dentate people: better clinical status - lower levels of impacts

Which oral conditions were reported as “causes” of impacts?

Different pattern of “causes” for different impacts Most common causes for most impacts: 1) Toothache / sensitive tooth / tooth

decay, 2) gum problems … Not necessarily so for impacts linked to psychological or social aspects of life

(e.g. smiling, social contacts)

Conclusions Quite positive general perception of dental health: Vast

majority perceived their dental health as good / very good

And for the majority of the population, their dental health did not have a negative impact on their life

Compared to 1998, improvement in OHIP-14 prevalence

However, a considerable proportion experienced impacts OHIP-14: 39% of dentate and 40% of edentate OIDP: 33% of dentate and 29% of edentate

In general, impacts were neither very frequent (OHIP-14) nor very severe (OIDP)…

Conclusions … but the impacts were severe among the minority that

reported them: 46% of those with at least one oral impact reported a score of 3 or

higher (scale: 0-5) in the OIDP severity ratings

Higher levels of impacts among dentate adults with denture(s): increased importance in future?

Among dentate, worse clinical status is linked to more impacts

Clear and consistent socioeconomic position gradient, with worse dental health perception and higher levels of impacts at successively lower SEP levels Importance of addressing health inequalities

Adult Dental Health Survey 2009

The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland.

The Office for National Statistics (ONS) was the lead contractor working in partnership with the National Centre for Social Research, the Northern Ireland Statistic & Research Agency, and a team of academics from the Universities of Birmingham, Cardiff, Dundee, Newcastle and University College London