Publications
Scottish Health Boards' Dental Epidemiological Programme
Report of the 1995/96 Survey of 5 Year old Children
Appendices
Appendix A Personnel involved in the survey Appendix B Calibration course details and dentist agreement for caries Appendix C Impact of the revised criteria on decayed and filled scores Appendix D Tooth and surface caries results and dental trauma Appendix E Oral cleanliness Appendix F SCOTS Index for developmental defects of enamel Appendix G Assessment of supra-gingival calculus Appendix H Codes used for assessment of caries and sealants Appendix I Abbreviations used for Health Boards Appendix J Maps of DMFT results for 14 year olds in Scotland, 1990/91 and 1994/95 Appendix K Map of DMFT results for 14 year olds in the UK, 1990/91
Tables
B1 Inter-dentist agreement from calibration trial B2 Intra-dentist agreement from survey G1 Supra-gingival calculus scores for each Health Board G2 Correlation between supra-gingival calculus and plaque levels G3 Correlation between supra-gingival calculus levels and DMFT G4 Corrleation between supra-gingival calculus and plaque levels
Figures
J1 Map of DMFT results for 14 year olds in Scotland (by Health Board) 1990/91 J2 Map of DMFT results for 14 year olds in Scotland (by Health Board) 1994/95 K1 Map of DMFT results for 14 year olds in Great Britain, 1990/91
Appendix A
Personnel involved in the survey
| CADOs, Purchasers (or their representatives) | Health Board Coordinators | Health Board |
|---|---|---|
| Mrs A Morrant | Mr A C Gerrish | Argyll & Clyde |
| Mr D McCall | Mr A J Swan | Ayrshire & Arran |
| Mr D W Clouting | Mr D W Clouting | Borders |
| Mr D McCall | Miss L S Gilliat | Dumfries & Galloway |
| Mr M C W Merrett (Acting CADO) | Mrs J Logan | Fife |
| Mr T R Watkins | Mr R Maxwell | Forth Valley |
| Miss C E Dawson | Miss C E Dawson | Grampian |
| Mrs A Morrant | Mr A Kippen | Greater Glasgow |
| Miss C E Dawson | Miss C E Dawson | Highland |
| Miss M Taylor | Miss M C Dyet | Lanarkshire |
| Mr R Naismith (representative) | Mrs Wight | Lothian |
| Mr G Ball | Mr G Ball | Orkney |
| Mr M Collins | Mr M Collins | Shetland |
| Mr M C W Merrett | Miss M Curnow | Tayside |
| Mrs C MacMillan (Acting CADO) | Mrs C MacMillan | Western Isles |
| Dental Examiners / Scribes | Health Board |
|---|---|
| Mr M Herbert / Miss L Taylor Mr D Watson / Mrs S McGougan Miss A Stoker / Mrs V McGowan | Argyll & Clyde |
| Mr A Swan / Mrs P Durham | Ayrshire & Arran |
| Mrs C Anderson / Mrs A Richardson Mrs M Land / Mrs P Aitchison | Borders |
| Mr G MacLean / Miss S Gorman Mr R Dickson / Mrs G Church | Dumfries & Galloway |
| Mrs J Logan / Miss E Pye Mr B Corkey / Miss L Henderson | Fife |
| Mr R Maxwell / Mrs E Kerr Mrs M Macdonald / Mrs M Lornie | Forth Valley |
| Miss G Bews / Miss T Ogston Mrs K Munro / Miss L Carmichael Mrs K Garner / Mrs M Mcrae | Grampian |
| Mrs Y Blair / Miss P Brown Mr D McElroy / Miss R Nicol Miss D Getty / Miss R Gorman Mr T Ferris / Mrs J King Miss E Reilly / Miss E Lynn Mrs D Macadam / Miss F Campbell | Greater Glasgow |
| Mr M Geddes / Mrs E Backhurst Mr J Shankland / Mrs M Robertson Mrs C Temple / Mrs I Clark | Highland |
| Miss M Shand / Mrs M Brown Mr A Bewick / Mrs S Dorian Miss A Furgol / Mrs C Taylor Mr J Morrison / Miss J Kerr Mrs Y Millar / Mrs M Hope | Lanarkshire |
| Miss M Campbell / Mrs E Gilhooley Mr J McConnachie / Mrs A Randall Mr D Sampson / Miss M Murdie | Lothian |
| Mrs M Nelson / Miss S Petrie | Orkney |
| Mr M Collins / Miss H Shearer | Shetland |
| Miss M Curnow / Mrs B Ritchie Miss G Macaulay / Miss L Thomson Dr S Manton / Mrs P Candy | Tayside |
| Miss C MacLeod / Mrs N MacSween Mr W Hart / Mrs J Morrison | Western Isles |
| Dr D Attwood / Miss J Wright | Observer |
| Calibration Course Staff | Title |
|---|---|
| Mr MCW Merrett (Tayside Health Board) | Organiser |
| Prof NB Pitts (Dental Health Services Research Unit) | Coordinator and Examiner Training |
| Dr C Pine (Dental Health Services Research Unit) Prof KW Stephen (Glasgow Dental Hospital and School) | Examiner Training |
| Ms JA Davies Miss HE Fyffe Miss L Hill Dr ZJ Nugent Mrs PA Smith (Dental Health Services Research Unit) | Data Collection and Calibration |
| Dr I Chestnutt (Glasgow Dental Hospital & School) Dr L Macpherson (Hon. Senior Registrar in Dental Public Health) Mr P Sweeney (Senior Registrar in Dental Public Health) | Observer |
| Name | Unit |
|---|---|
| Data Processing | |
| Dr ZJ Nugent | (Dental Health Services Research Unit) |
| Mr MR Saradijian Maralan | (Dental Health Services Research Unit) |
| Analyses and Report Preparation | |
| Miss HE Fyffe | (Dental Health Services Research Unit) |
| Dr ZJ Nugent | (Dental Health Services Research Unit) |
| Prof NB Pitts | (Dental Health Services Research Unit) The Reprographics Unit of Duncan of Jordanstone College |
Appendix B
Training and Calibration
The training and calibration courses for this second survey of 14 year old children was held in Perth as it was considered to be a good central location relative to the other geographical areas in Scotland from where the examining teams have to travel and has proved to offer excellent facilities and schools for this exercise over many years.
In order to achieve meaningful results in a calibration assessment it is important that there is an appreciable level of disease, in the subjects being examined, for the dentists to diagnose.
The large number of people involved in the training and calibration courses (examiners, scribes, co-ordinators, trainers etc.) for the Scottish Health Boards' Dental Epidemiological Programme surveys makes it necessary to run two separate two-day courses. The first course was held on the 7th and 8th of November 1994 and the second was held, later that same week, on the 10th and 11th of November. Both courses were held in a hotel in Perth and followed the basic schedule previously used. Illustrated training lessons on the codes and criteria (updated to accommodate the latest modifications from BASCD) were followed by discussion sessions. Clinical training was undertaken in the morning sessions, using children at one of the two schools. Calibration took place in the afternoon, following the clinical training session, and was followed by a final discussion session. The course organiser was Mr MCW Merrett and the training elements were provided by Professor NB Pitts and the Dental Health Services Research Unit.
Perth Grammar School (Rector Mr D Bader) and Perth High School (Rector Mr C Kiddie) kindly agreed to allow the training and calibration courses to take place on their premises. Without the cooperation of the children, their parents and the staff at the school, the training and calibration courses would not have been possible. The Scottish Health Boards' Dental Epidemiological Programme extends thanks to them all.
Examiner Agreement
Appendix C
IMPACT OF THE REVISED CRITERIA ON DECAYED AND FILLEDSCORES
The British Association for the Study of Community Dentistry (BASCD) is continually working to try to improve the quality of the national caries prevalence data in Great Britain. This is a particularly important activity when the presentation of dental caries is changing and NHS dental services are evolving. It had become apparent that there were some local variations in the interpretation of the diagnostic criteria and this led to the agreement that "tighter" criteria for decay into dentine were required. Prior to the 1992/93 examinations of 12 year olds children in Great Britain, BASCD revised the definition of dentinal caries to read: "if in the opinion of a trained examiner a surface has decay into dentine (regardless of whether there is a cavity) a surface will be coded as decayed".
Feed- back received from SHBDEP examiners showed that the alteration to the criteria was welcomed by the majority as being more in line with their own diagnostic choices and less likely to systematically underscore disease than the previous criteria had been. The level of inter-dentist agreement in this year's survey (Table B1) is greater than was seen in the 1990/91 survey of 14 year olds.
Appendix C of the 1992/93 Report (Pitts et al., 1993) outlined an exploratory study conducted by volunteer examiners which permitted a comparison of duplicate caries scores of the same children under the intial and revised protocols. These data allow a mathematical estimation of the change in observed caries scores that might be attributed to the revision of the criteria alone.
Figure C1a shows the transformation for %DMFT. It can be seen that the value for %DMFT=0 predicted for 1994 (18.6%) was exceeded as the actual value observed was 26.1%. Thus we can deduce that there has been a rise in the %DMFT=0. The mean DMFT value predicted for 1994, had there been no change, was 4.00, while the value actually recorded was 3.14, thus there has been a fall in the overall DMFT.
Figure C1b shows that there is a very close match between the percentages of DT predicted for 1994 if there had been no change in the criteria and those actually observed in 1994. Looking at the mean DT, the discrepancy between the predicted and observed means are small, suggesting that there has been little change in the D component of the Index.
However on looking at Figure C1c it becomes apparent that there is a considerable increase in the %FT=0 (42.9% observed versus 31.6% predicted) and that the mean FT has decreased from a predicted 2.41 to an observed value of 1.62.
Thus it can be concluded that, when the change in criteria brought in (in 1992) to improve comparability with other parts of Great Britain are taken into account, the predominant change observed between 1990/91 and 1994/95 is the decrease in the number of fillings being provided. This change is far greater than the small decrease in decay seen overall. Values derived from these transformation have been incorporated, where appropriate, in the parts of the Report dealing with trends over time (see Figures 4 and 5).
It should be appreciated that the revised criteria, in detecting more dentine caries, are giving a truer estimate of disease levels and it is these values that should be used from now on. The reproducibility achieved by examiners in detecting decay has improved since the modified criteria were adopted.
Appendix D
TOOTH AND SURFACE CARIES RESULTS AND DENTAL TRAUMA
| Table D1: Mean number of surfaces decayed (DS), missing* (MS), filled** (FS), sealed ($S) and with sealant restorations (NS), per child for each Health Board. [D defined as decay into dentine]. | |||||||
| Health Board | Total | DS | MS | FS | DFS | $S | NS |
| Argyll & Clyde | 480 | 1.39 | 1.36 | 2.59 | 3.98 | 2.71 | 0.02 |
| Ayrshire & Arran | 350 | 1.00 | 0.98 | 2.96 | 3.96 | 2.72 | 0.04 |
| Borders | 233 | 1.18 | 0.86 | 2.36 | 3.54 | 1.65 | 0.05 |
| Dumfries & Galloway | 217 | 2.38 | 1.05 | 2.57 | 4.95 | 1.73 | 0.02 |
| Fife | 388 | 1.83 | 1.86 | 3.39 | 5.22 | 3.18 | 0.02 |
| Forth Valley | 296 | 1.56 | 1.00 | 1.59 | 3.15 | 4.22 | 0.07 |
| Grampian | 416 | 2.38 | 1.31 | 2.86 | 5.24 | 1.36 | 0.04 |
| Greater Glasgow | 790 | 3.02 | 1.93 | 3.44 | 6.46 | 2.70 | 0.09 |
| Highland | 275 | 2.48 | 1.25 | 2.33 | 4.80 | 3.94 | 0.05 |
| Lanarkshire | 869 | 2.75 | 1.58 | 4.35 | 7.10 | 3.39 | 0.05 |
| Lothian | 552 | 1.45 | 0.95 | 2.02 | 3.47 | 2.80 | 0.02 |
| Orkney | 252 | 1.28 | 0.44 | 2.01 | 3.29 | 3.64 | 0.02 |
| Shetland | 338 | 1.00 | 0.58 | 3.35 | 4.35 | 7.05 | 0.03 |
| Tayside | 318 | 1.90 | 1.69 | 2.90 | 4.80 | 3.23 | 0.03 |
| Western Isles | 233 | 2.59 | 1.74 | 3.69 | 6.28 | 3.97 | 0.07 |
| Scotland (weighted values) | 6007 | 2.08 | 1.41 | 2.96 | 5.04 | 2.87 | 0.04 |
* 4 surfaces are counted for a missing anterior and 5 for a posterior tooth.
** Filled surfaces include codes F, N and R.
Table D2 Distribution of Decay
Figure D1 Distribution of Caries Experience by Surface
DENTAL TRAUMA
This study recorded 12 teeth lost due to trauma in 12 subjects. Only incisors (9 upper, 3 lower) were involved.
627 teeth in 472 subjects were recorded as present but displaying trauma. The maximum number of traumatised teeth in any subject was six. Traumatised teeth were predominantly maxillary (83%) and incisors in all but two cases.
Overall 8.0% of the sample was affected by trauma. The sexes were significantly different in that 10.2% of boys, but only 5.8% of girls were affected (p<0.001). Regions also differed significantly in the frequency of children affected by trauma, from a low of 2.3% in Dumfries and Galloway, to a high of 11.6% in Highland.
No assessment of dental trauma was included in the previous survey of 14 year old children, however the figure presented here are similar (if marginally higher) than those reported for 12 year olds in 1992/93 (Pitts et al., 1993).
Appendix E
Appendix F
SCOTS INDEX FOR DEVELOPMENTAL DEFECTS OF ENAMEL
The SCOTS Index (developed for the Scottish Health Boards, including the Child's assessment of any Opacities / Hypoplasias graded by extent in Thirds and by Symmetry) was initially assessed in the 1990/91 survey of 14 year olds as a potential public health index for "developmental defects" or anomalies of enamel. It was designed for use in survey settings where time and equipment may be limited. The assessment was made, wet, on the upper four permanent incisor teeth. Anomalies smaller than 1mm are excluded.
Each of the four upper incisors of 6007 subjects was assigned to one of the following SCOTS categories:-
- 0. Nil
- 1. Demarcated Opacities
- 2. Diffuse Opacities
- 3. Hypoplasia
- 4. 1 & 2
- 5. 1 & 3
- 6. 2 & 3
- 7. 1 & 2 & 3
- 9. Not scoreable (eg examination field obscured by orthodontic band)
The frequencies of each of the three types of anomalies are shown in Table F1 (where one subject may have shown any or all anomalies). The prevalence of demarcated and diffuse opacities differ between Health Boards, ranging from 5-16% for demarcated opacities and 9-26% for diffuse opacities. The SCOTS Index classification for a subject is the highest single value assigned to any scored tooth (excluding 9). 3.3% of the 6007 subjects had no scoreable teeth. The frequencies of SCOTS classifications are shown in Table F2. There were fewer with SCOTS code 1, demarcated opacities (7.9%) than with SCOTS code 2, diffuse opacities (15.7%). Of the diffuse opacities over half (54.8%) were coded symmetrical. These results differ markedly from those obtained in the previous survey of 14 year olds in which the proportion of SCOTS code 1, demarcated opacities (10.2%), was higher than that for SCOTS code 2, diffuse opacities (7.9%).
Subjects were asked "Do you think you have any marks on your upper front teeth which won't brush off?" Of 1570 subjects who had a SCOTS lesion (codes 1-6,8) and answered the question regarding marks on their teeth 26% were aware of a mark on a tooth with a SCOTS lesion. Of 937 subjects who had a tooth coded SCOTS 2 and answered the question on marks on their teeth, 22% were aware of a mark on a tooth coded 2 (diffuse opacity).
SCOTS anomalies differ in extent and symmetry, although sufficient data for analysis was only available for types 1, 2 and 3 (Table F3).
APPENDIX G
ASSESSMENT OF SUPRA-GINGIVAL CALCULUS
The incorporation of a brief addition to the SHBDEP examination in order to make an assessment of the presence of supra-gingival calculus on the lingual and approximal aspects of the four lower incisors was a new development in this year's survey.
Teeth were examined, wet, by running a CPITN probe immediately above the gingival margin on the lingual and approximal aspects of each of the four lower incisors. The codes employed are set out below:
| Condition | Code |
| no calculus visible or detectable | 0 |
| calculus present | 1 |
| assessment not possible (eg tooth missing, orthodontic bands etc) | 9 |
The results from this attempt to assess supra-gingival calculus, from an epidemiological point of view, across Scotland are outlined in Tables G1 (Scotland, unweighted data) G2, G3 and G4.
| Table G1: Presence of supra-gingival calculus | |
| Proportion of subjects | |
| No calculus present | 72.1 |
| Calculus present at some sites | 14.1 |
| Calculus present at all sites | 13.8 |
| Table G2: Correlation between supra-gingival calculus and plaque levels. | |||
| No plaque present | Plaque present at some sites | Plaque present at all sites | |
| No calculus present | 49.1% | 43.8% | 7.2% |
| Calculus present at some sites | 39.3% | 52.8% | 7.9% |
| Calculus present at all sites | 30.1% | 53.5% | 16.4% |
Spearman Correlation=+0.146, p<0.001.
| Table G3: Correlation between supra-gingival calculus levels and DMFT. | ||
| Low DMFT | High DMFT | |
| No calculus present | 51.0% | 49.0% |
| Calculus present at some sites | 54.5% | 45.5% |
| Calculus present at all sites | 55.4% | 44.6% |
Mantel-Haenszel test for linear association=7.01548, p<0.01
Low DMFT defined as DMFT less than or equal to 2; high DMFT defined as greater than 2.
| Table G4: Correlation between plaque levels and DMFT. | ||
| Low DMFT | High DMFT | |
| No plaque present | 58.3% | 41.7% |
| Plaque present at some sites | 49.6% | 50.4% |
| Plaque present at all sites | 33.1% | 66.9% |
Mantel-Haenszel test for linear association=115.14389, p<0.0001
Low DMFT defined as DMFT less than or equal to 2; high DMFT defined as greater than 2.
Appendix H
CODES USED FOR ASSESSMENT OF CARIES AND SEALANTS
| Tooth Codes | Extracted (caries) | 6 |
| Extracted (ortho) | 7 | |
| Unerupted | U | |
| Missing (trauma) | T | |
| Surface Codes | Present and "sound" | G |
| Arrested dentine caries | 1 | |
| Decayed, dentine visual | 2V | |
| Decayed, dentine cavity | 2C | |
| Unrestorable | 3 | |
| Filled and decayed | 4 | |
| Filled, no decay | F | |
| Filled, needs replacing | R | |
| Sealed surface, type unknown | $ | |
| Obvious sealant restoration | N | |
| Crown/advanced procedure | C | |
| Excluded | 9 | |
| Traumatised surface | t |
Appendix I
ABBREVIATIONS USED FOR HEALTH BOARDS
| Health Board | Abbreviation |
| Argyll & Clyde | A&A |
| Ayrshire & Arran | A&C |
| Borders | BOR |
| Dumfries & Galloway | D&G |
| Fife | FIFE |
| Forth Valley | FV |
| Grampian | GRA |
| Greater Glasgow | GG |
| Highland | HIGH |
| Lanarkshire | LAN |
| Lothian | LOTH |
| Orkney | ORK |
| Shetland | SHET |
| Tayside | TAY |
| Western Isles | WI |
Appendix J
Figure J1: MAP OF DMFT RESULTS FOR 14 YEAR OLDS IN SCOTLAND (BY HEALTH BOARD) 1990/91
Figure J1: MAP OF DMFT RESULTS FOR 14 YEAR OLDS IN SCOTLAND (BY HEALTH BOARD) 1994/95
Appendix K
Figure K1: MAP OF DMFT RESULTS FOR 14 YEAR OLDS IN GREAT BRITAIN, 1990/91
Return to Report of the 1994/95 Survey of 5 Year old Children homepage.
| Contact Us | A to Z Index | Search the University | Site Map | |||
| Maintained by: B.C.Bonner at DHSRU | Disclaimer| Privacy | Valid XHTML1.0 | ||