Reports and abstracts of articles originally published in Community Dental Health
Published in: Supplement 1; March 1997Patterns of change and results overview 1985/6-1995/6 from the British Association for the Study of Community Dentistry (BASCD) co-ordinated National Health Service surveys of caries prevalence
Z.J. Nugent(1) and N.B. Pitts(2)
1 Statistician / IT Manager, Dental Health Services Research Unit, University
of Dundee, Dundee, UK;
2 BASCD Dental Epidemiology Programme Scientific Coordinator, Dental Health
Services Research Unit, University of Dundee, Dundee, UK.
- Correspondence to:
- Dr Z Nugent,
- Dental Health Services Research Unit,
- Dental School,
- Park Place,
- Dundee, Scotland, DD1 4HR.
Community Dental Health 14, (Suppl 1) 30-54.
This paper collates the results of all the surveys conducted under the BASCD co- ordinated National Health Service surveys of caries prevalence conducted between 1985/86 and 1995/96. First the patterns of change in the dental health of 5-year-olds are considered for the period 1987 - 1995. Then the patterns of change in the dental health of adolescents between 1988-1994 are examined and summarized. Lastly summary tables present key data from the last 10 years of survey results grouped by variable.
Patterns of change in the dental health of 5-year-olds: 1987-1995
Introduction
The British Association for the Study of Community Dentistry (BASCD) has coordinated biennial national surveys of five-year-old children undertaken since, in England and Wales, 1985/86 (Dowell, 1988), in Great Britain during: 1987/88 (Dowell and Evans, 1989), 1989/90 (Evans and Dowell, 1991), 1991/92 (Pitts and Palmer, 1994) and 1993/94 (Pitts and Palmer, 1995) and in the United Kingdom during 1995/96 (Pitts and Evans, 1997). Sufficient data is now available to examine changes in epidemiological measures through time.
Materials and Methods
The criteria used for BASCD surveys have been outlined elsewhere in this Supplement (Pitts et al,. 1997). The data from 1985 has been excluded from the analyses because at that time the BASCD conventions and criteria had not been sufficiently finalized at this point with regard to sampling methods and the age groups to be examined.
Complete records of d3mft and its components are available for 133 health districts in England, all 9 districts in Wales and all 15 health boards in Scotland. In addition, 129 areas (108 English districts; 6 Welsh districts, 15 Scottish health boards) had complete data for the percentage of the population with d3t > 0 and d3mf > 0.
Analyses were carried out on the following observations: d3t, ft, d3mft, care index (ft/d3mft x 100%), percentage of population with d3mf>0 and with d3t>0, d3t for subjects with d3t>0 and d3mft for subjects with d3mf>0.
The analyses were undertaken as described by Montgomery (1984) for a two factor factorial design with fixed effects and one observation per cell. The linear regression component on time was calculated as described by Sokal and Rohlf (1981) for multiple values of the dependent for each value of the independent.
The skewedness of the d3t, ft and d3mft data was corrected by square root transformation. The percentage data was expressed as proportion and the square root of each value was arcsine transformed.
Results
Areas (district in England and Wales; health board in Scotland) differ significantly in all the factors examined (Table 1).
The d3mft, the "highlight" of dental epidemiological data, has changed in the course of these studies. However, the change has not been directional, and the proportion of children with disease appears to have remained constant. As implied by these observations, the disease levels in those with a history of disease (d3mft>0) has also not increased or deceased significantly (Table 1, Figures 1 and 2).
Beneath this overall uniformity, changes in the make-up of the disease have occurred. Both d3t and the proportion of the population with d3t > 0 have increased, although disease levels in those with decay have not changed directionally. The ft component has dropped and so, as implied by the above, has the care index (Table 1, Figures 1 and 2).
Discussion
Dental caries among five year olds appears to be changing in Great Britain. Improvements in disease levels observed in previous studies, such as the Office of Population Censuses and Surveys (OPCS) 1983 survey (Todd and Dodd 1985) have now ceased (Palmer and Pitts, 1994). At the same time, less of the extant disease is being treated restoratively. The detail of the exclusion criteria for dentinal decay diagnosis has changed slightly during the course of these studies, but a piloting project of the new criteria suggest that the observed rise in d3t cannot be entirely subscribed to this (Pitts, et al., 1994).
Patterns of change in the dental health of adolescents: 1988-1994
Introduction
The British Association for the Study of Community Dentistry (BASCD) has coordinated biennial national surveys of adolescents (12 and 14 year old children) since 1986. Surveys of 14-year-old children have been undertaken in Great Britain during 1986/87 (Dowell and Evans, 1988) , 1990/91 (Pitts and Palmer, 1994) and for the United Kingdom in 1994/95 (Pitts and Evans, 1996). Surveys of 12-year-old children have been undertaken in Great Britain during 1988/89 (Evans and Dowell, 1990), 1992/93 (Pitts and Palmer, 1994). Sufficient data is now available to examine changes in epidemiological measures through time.
Materials and Methods
The criteria used for BASCD surveys have been outlined elsewhere in this supplement (Pitts et al,. 1997). The data from 1986 has been excluded from the analyses because the BASCD criteria had not at that time been finalized sufficiently with regard to sampling methods and the age group to be examined.
Complete records of d3MFT and its components are available for 131 health districts in England, all 9 districts in Wales and all 15 health boards in Scotland for twelve year olds in 1988 and 1992. In addition, 152 areas (128 English districts; all 9 Welsh districts, 15 Scottish health boards) had complete data for the percentage of the population with d3>0 and d3MF> 0.
Complete records of d3MFT and its components are available for 151 health districts in England, all 9 districts in Wales and all 15 health boards in Scotland for fourteen year olds in 1990 and 1992. In addition, 173 areas (149 English districts; all 9 Welsh districts, 15 Scottish health boards) had complete data for the percentage of the population with d3>0 and d3MF> 0.
Analyses were carried out on the following observations: d3T, FT, d3MFT care index (FT/d3MFT x 100%), percentage of population with d3MF > 0, and d3MFT for subjects with d3MF > 0. Analyses were undertaken using paired t-tests.
Results
The d3MFT, the "highlight" of dental epidemiological data, has changed in the course of these studies, having dropped significantly in both twelve and fourteen year olds (Table 2). However, the change has not been common to all components. d3T has increased, while both MT and FT have fallen. This has resulted in a sharp drop in the Care Index. (FT*100%/d3MFT).
Discussion
There has been an undeniable decrease in the overall levels of d3MFT in adolescents over the period of study. However the worrying aspect in the pattern of care being provided is that mean values of d3T have at the same time increased significantly in both 12 and 14 year old age groups while mean FT has decreased significantly. The resulting falls in the proportion of dentine caries restored (care index percentage) of -14.5 per cent (to a value of 57.8 per cent) for 12-year- olds and of -14.3 per cent (to a value of 60.5 per cent) for 14-year- olds give cause for concern. This level of undertreatment in permanent teeth is incompatible with most contemporary treatment strategies. Although the causes may be multi-factorial, it will be interesting to see whether this pattern changes after the September 1996 modifications to the General Dental Service contract.
Results overview 1985/6-1995/6 from the BASCD co-ordinated NHS surveys
The following tables group together the key results from the last decade of BASCD co-ordinated NHS surveys. Tables 3 - 7 set out the sample sizes, and results for d3mft / d3MFT, percentage d3mft>0 / d3MFT>0, d3t / d3T and care index percentage for individuals examined in the BASCD co-ordinated NHS surveys of children 1985-1995.
References
Dowell, T. B. (1988): The caries experience of 5 year old children in England and Wales. A survey coordinated by the British Association for the Study of Community Dentistry in 1985-86. Community Dental Health 5, 185-197
Dowell, T.B. and Evans, D.J. (1988): The dental caries experience of 14 year old children in Great Britain. A survey coordinated by the British Association for the Study of Community Dentistry in 1986-87. Community Dental Health 5, 395-410.
Dowell, T.B. and Evans, D.J. (1989): The dental caries experience of 5 year old children in Great Britain. A survey coordinated by the British Association for the Study of Community Dentistry in 1987-88. Community Dental Health 6, 271-279.
Evans, D.J. and Dowell T.B. (1990): The dental caries experience of 12 year old children in Great Britain. A survey coordinated by the British Association for the Study of Community Dentistry in 1988-89. Community Dental Health 7, 307-314.
Evans, D.J. and Dowell T.B (1991): The dental caries experience of 5-year-old children in Great Britain. A survey coordinated by the British Association for the Study of Community Dentistry in 1989-90. Community Dental Health 8, 185-194.
Montgomery (1984): Design and analysis of experiments. pp 211-215. New York: John Wiley and Sons.
Palmer, J. and Pitts, N.B. (1994): Child Dental Health - is it still good news?. Br Dent J 177, 235-237.
Pitts, N.B. and Evans, D.J. (1996): The dental caries experience of 14-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1994/95. Community Dental Health 13, 51-58.
Pitts, N.B. and Evans, D.J. (1997): The dental caries experience of 5-year-old children in the United Kingdom. Surveys coordinated by the British Association for the Study of Community Dentistry in 1995/96. Community Dental Health 14, 47-52.
Pitts, N.B., Evans, D.J. and Pine, C.M. (1997): British Association for the Study of Community Dentistry (BASCD) diagnostic criteria for caries prevalence surveys - 1996/97. Community Dental Health 14, (Suppl 1) 6-9.
Pitts, N.B., Fyffe, H.E. and Nugent, Z. (1994): Scottish Health Boards' Dental Epidemiological Programme Report of the 1993/4 survey of five-year-old children. Dundee: University of Dundee.
Pitts, N.B. and Palmer, J. (1994): The dental caries experience of 5-, 12- and 14- year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1991/92, 1992/93 and 1990-91. Community Dental Health 11, 42-52.
Pitts, N.B. and Palmer, J. (1995): The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1993/94. Community Dental Health 12, 52-58.
Sokal, R.R and Rohlf, F.J. (1981): Biometry. 2nd edn. pp 477-491. San Francisco: W.H. Freeman and Company.
Todd, J.E. and and Dodd, T. (1985): Children's dental health in the United Kingdom 1983. London: Office of Population Census and Surveys.
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