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Scottish Health Boards' Dental Epidemiological Programme

Report of the 1995/96 Survey of 5 Year old Children


Appendices

Appendix APersonnel involved in the survey
Appendix BTraining and calibration
Appendix CInter and intra-examiner agreement
Appendix DCodes used for assessment of caries and sealants
Appendix EAbbreviations used for Health Boards
Appendix FComparison of "d3mft" and "d3" in 1993 and 1995 with confidence limits
Appendix GCaries experience and distribution by surface
Appendix HOral cleanliness
Appendix IMaps of d3mft results for Great Britain and Scotland

List of Tables

C1Inter-dentist agreement from calibration trial
C2Intra-dentist agreement from survey
G1Caries data, by surface, for each Health Board
G2Distribution of decay by tooth surface for each Health Board
H1Plaque scores and associated d3mft values

List of Figures

F1Comparison of d3mft in 1993/94 and 1995/96
F2Comparison of d3s in 1993/94 and 1995/96
H1Distribution of plaque scores for each Health Board
I1BASCD UK map showing geographical variation in d3mft, 1993/94
I2SHBDEP map showing d3mft by Health Board for 1995/96

Appendix A

Personnel involved in the survey

CADOs/Consultants
(or their representatives)
Health Board
Mrs A MorrantArgyll and Clyde
Mr D McCallAyrshire and Arran
Mr G Ball Borders
Mr D McCallDumfries and Galloway
Mr G BallFife
Mr T R WatkinsForth Valley
Miss C E DawsonGrampian
Mrs A MorrantGreater Glasgow
Miss C E DawsonHighland
Miss M M TaylorLanarkshire
Mr R Naysmith (representative)Lothian
Mrs M NelsonOrkney
Mr M CollinsShetland
Mr M C W MerrettTayside
Mrs C MacmillanWestern Isles

Health Board Co-ordinatorsHealth Board
Mr A C GerrishArgyll and Clyde
Mr A J SwanAyrshire and Arran
Mr D W CloutingBorders
Miss L S GilliatDumfries and Galloway
Mrs J LoganFife
Mr R MaxwellForth Valley
Miss C E DawsonGrampian
Mr A KippenGreater Glasgow
Miss C E DawsonHighland
Miss M C DyetLanarkshire
Mrs C WightLothian
Mrs M NelsonOrkney
Mr M CollinsShetland
Miss M M T CurnowTayside
Mrs C MacmillanWestern Isles

Dental Examiners / ScribesHealth Board
Mr R Lawson / Miss A CampbellArgyll and Clyde
Miss A Stoker / Mrs M HutchisonArgyll and Clyde
Mr D Watson / Mrs S McGougan Argyll and Clyde
Mr A Swan / Miss C McClure Ayrshire and Arran
Mrs C Anderson / Miss A RichardsonBorders
Mrs M Land / Mrs L DumperBorders
Miss C Oliver / Mrs K PaxtonDumfries and Galloway
Mr L Seath / Mrs A PaulDumfries and Galloway
Mrs J Logan / Miss E PyeFife
Miss E Moyes / Mrs C MaxwellFife
Mr R Maxwell / Mrs E KerrForth Valley
Mrs M Macdonald / Ms N KewellForth Valley
Mrs N Walker / Mrs M LairdGrampian
Miss G Bews / Miss T OgstonGrampian
Mrs B Smith / Miss A BirssGrampian
Mr D McElroy / Mrs F HughesGreater Glasgow
Miss E Reilly / Mrs E LynnGreater Glasgow
Mrs A Macmillan / Miss R NicollGreater Glasgow
Miss S Dunseith / Mrs S KennedyGreater Glasgow
Mrs L Ovenstone / Miss C GartonGreater Glasgow
Mrs D Macadam / Mrs F CampbellGreater Glasgow
Mrs M Barr / Mrs J StrongGreater Glasgow
Mr J Shankland / Mrs M RobertsonHighland
Mrs C Temple / Mrs J AndersonHighland
Mr M Geddes / Mrs E BackhurstHighland
Mr A Bewick / Mrs S DorrianLanarkshire
Miss A Furgol / Mrs C TaylorLanarkshire
Miss M Shand / Mrs M BrownLanarkshire
Mr J Morrison / Miss J KerrLanarkshire
Mrs Y Millar / Mrs M HopeLanarkshire
Miss M Campbell / Mrs E GilhooleyLothian
Mr J McConnachie / Mrs A RandallLothian
Mrs R McGonigle / Miss D ScottLothian
Mr D Sampson / Miss M MurdieLothian
Mrs M Nelson / Miss S PetrieOrkney
Mr M Collins / Miss H ShearerShetland
Miss M Curnow / Mrs B RitchieTayside
Miss G Macaulay / Miss K IngramTayside
Miss C McLeod / Mrs N MacSweenWestern Isles
Mr W Hart / Mrs J MorrisonWestern Isles

Calibration Course StaffTitle
Mr M C W Merrett
(Tayside Health Board)
Organiser
Professor N B Pitts
(Dental Health Services Research Unit)
Co-ordinator and Examiner Training
Dr C Pine
(Dental Health Services Research Unit)
Examiner Training
Professor K Stephen
(Glasgow Dental Hospital and School)
Adviser
Miss H E Fyffe
(Dental Health Services Research Unit)
Organisation, Data collection and Calibration
Dr L Broumley
(Dental Health Services Research Unit)
Data collection and Calibration
Miss L Hill
(Dental Health Services Research Unit)
Data collection and Calibration
Dr Z J Nugent
(Dental Health Services Research Unit)
Data collection and Calibration
Mrs G Topping
(Dental Health Services Research Unit)
Data collection and Calibration
Mr P Sweeney
(Senior Registrar in Dental Public Health)
Observer

Organisational assistance was provided by staff of the
Community Dental Service, Perth and Kinross Healthcare NHS Trust


NameUnit
Data Processing
Dr Z J Nugent (Dental Health Services Research Unit) with data entry assistance from Ms G Oliphant
Analyses and Report Preparation
Ms J A Davies (Dental Health Services Research Unit)
Dr Z J Nugent (Dental Health Services Research Unit)
Professor N B Pitts (Dental Health Services Research Unit)

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Appendix B

Training and Calibration

The training and calibration course for this fifth SHBDEP survey of 5 year old children in Scotland was once again held in Perth, as this has proved to be a good central location for all the areas from which examining teams have to travel.

As in previous years, there were a large number of people involved in the organisation and undertaking of the training and calibration and two separate courses were needed to accommodate the 40 teams. The first course was held on Monday and Tuesday, 6th and 7th November, with the second being held on Thursday and Friday, 9th and 10th November, 1995. The courses were undertaken in a hotel in Perth and followed the schedules from previous years. Illustrated training sessions on the codes and criteria, updated to accommodate the latest modifications from BASCD, and using the UK BASCD Trainers' Pack (Mitropoulos, Pitts & Deery, 1992) were followed by discussion sessions. Clinical training sessions were undertaken using schoolchildren on the morning of the second day, and were followed by the calibration sessions in the afternoon. Final discussions were held on completion of the calibration. The course organiser was Mr M C W Merrett and the training was provided by Professor N B Pitts and DHSRU.

Letham Primary School (Headteacher, Mrs E Matheson) and North Muirton Primary School (Headteacher, Mr P Pierson) kindly allowed the training and calibration courses to take place on their premises. Without the cooperation of the children, their parents and the staff of these schools the courses could not take place. The Scottish Health Boardsū Dental Epidemiological Programme is grateful to them all.

Reference

Mitropoulos C, Pitts NB & Deery C. BASCD Trainers Pack for Caries Prevalence Studies, 1992/93. University of Dundee, 1992.

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Appendix C

Inter and intra-examiner agreement

Table C1
Inter-dentist agreement

GroupABCD
Number of Dentists10101010
Number of Subjects10101010
deciduous teeth
Mean191176.8165.7194
Standard Deviation00.421.340
Range-176-177162-167-
dt
Mean25.442.417.319.4
Standard Deviation4.433.034.163.03
Range20-3238-479-2316-26
mt
Mean91426.94
Standard Deviation000.320
Range--26-27-
ft
Mean00.63.43
Standard Deviation00.521.90.47
Range-0-11-62-4
d3mft
Mean34.45747.626.4
Standard Deviation4.432.873.172.67
Range29-4152-6141-5323-32
Kappa (surfaces)
Mean0.890.890.860.93
Standard Deviation0.020.020.120.01
Range0.84-0.950.86-0.920.57-0.970.90-0.95
Dice (deciduous teeth)
Mean10.9990.9931
Standard Deviation00.0010.0080
Range-0.997-10.970-1-
Kappa (teeth)
Mean0.80.930.880.86
Standard Deviation0.050.020.050.04
Range0.71-0.900.88-0.970.78-0.960.79-0.95

Table C2

Intra-dentist agreement for decayed (d3) and filled (f) teeth and surfaces as assessed by Kappa and Dice Similarity measure (value of 1 denotes perfect agreement and value of 0 denotes no agreement).

DentistChildren Teeth  Surfaces 
KappaDice for d3Dice for fKappaDice for d3Dice for f
1210.941.000.550.991.000.63
2240.990.990.910.990.990.96
3181.001.001.000.990.991.00
4131.001.00(ft=0)1.001.001.00
5140.980.971.000.990.961.00
6110.970.97(ft=0)0.970.951.00
7150.990.991.000.970.940.95
8270.990.991.000.980.970.97
9110.900.920.750.940.930.89
10230.990.991.000.980.971.00
11130.980.981.000.970.991.00
12231.001.001.000.980.991.00
13230.960.950.860.970.940.86
14110.970.980.930.960.920.97
15101.001.00(no fillings)0.990.97(no fillings)
1690.960.950.670.980.910.67
17100.990.99(ft=0)0.990.991.00
1890.910.891.000.980.921.00
19190.980.981.000.990.991.00
20201.001.001.000.991.001.00
21300.990.991.000.990.961.00
22230.920.901.000.970.930.88
23180.980.971.000.990.961.00
24271.001.001.000.990.991.00
25271.001.001.000.980.991.00
26220.970.95(no fillings)0.990.93(no fillings)
27270.990.991.000.990.981.00
28251.001.001.000.991.000.97
29220.990.991.000.990.991.00
3061.001.001.001.001.001.00
31141.001.001.000.970.971.00
3281.001.001.000.980.950.94
33181.001.001.000.991.001.00
34190.990.991.000.990.980.96
35220.990.980.860.990.980.89
36220.980.981.000.990.981.00
37270.990.981.000.990.991.00
38271.001.001.000.991.000.97
39110.960.960.900.960.940.88
4041.001.00(no fillings)1.001.00(no fillings)

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Appendix D

Codes used for the assessment of caries and sealants

Tooth Codes
Extracted (caries) 6
Extracted (ortho) 7
Unerupted U
Missing (trauma) T
Surface Codes
Present and "sound" G
Hard, 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 $
Obvious sealant restoration N
Crown / advanced procedure C
Excluded 9
Traumatised surface t

* The way in which examiners use these codes precludes a simplistic comparison with what might have been scored prior to the introduction of code 2V.

The survey criteria:

The caries into dentine (d3) diagnostic threshold is used throughout the SHBDEP and BASCD surveys. This convention ensures comparability with other surveys but specifically excludes all decayed surfaces with "white spot" or "brown spot" caries in enamel. The examinations are clinical field examinations without the benefit of a dental operating light, compressed air, saliva control, radiographs or other diagnostic aids. Examinations by dentists in dental surgeries cannot therefore be expected to yield the same results (SNAP report on dental caries in children - Pitts et al, 1994).

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Appendix E

Abbreviations used for Health Boards

Argyll and ClydeA&C
Ayrshire and ArranA&A
BordersBor
Dumfries and GallowayD&G
FifeFife
Forth ValleyFV
GrampianGra
Greater Glasgow GG
HighlandHig
LanarkshireLan
LothianLoth
OrkneyOrk
ShetlandShet
TaysideTay
Western IslesWI

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Appendix F

Comparison of "d3mft" and "d3" in 1993 and 1995 with confidence limits

Figure F1

Decayed, missing and filled teeth (d3mft) in 5 year old Scottish children in 1993/94 and 1995/96 - a comparison showing mean values and estimated 95% confidence limits.

Figure F1

Figure F2

Decayed surfaces (d3s) in 5 year old Scottish children in 1993/94 and 1995/96 - a comparison showing mean values and estimated 95% confidence limits.

Figure F2

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Appendix G

Caries experience and distribution by surface

Table G1

Mean number of surfaces decayed (d3s - Total, C1, C2, C3), missing* (ms), filled (fs) and sealed/sealant restoration (ss) per child for each Health Board (decay defined as decay into dentine).

d3s
Health BoardTotal **C1sC2sc3smsfsdfsss
Argyll & Clyde4.720.093.491.031.750.395.100.05
Ayrshire & Arran4.870.003.781.001.930.685.550.04
Borders3.040.002.320.571.020.813.850.01
Dumfries & Galloway6.840.145.451.121.710.357.190.01
Fife5.050.014.070.821.530.295.340.00
Forth Valley4.390.303.110.861.770.314.700.04
Grampian4.610.084.030.311.110.405.000.01
Greater Glasgow5.650.104.470.962.490.456.100.08
Highland5.040.054.470.421.570.595.640.15
Lanarkshire6.360.144.651.432.020.436.790.01
Lothian3.460.082.890.421.050.523.980.03
Orkney2.470.072.030.241.220.843.310.24
Shetland3.150.032.011.081.270.673.822.68
Tayside3.980.073.260.491.420.444.420.03
Western Isles4.900.243.850.700.751.596.490.11
Scotland (weighted values)4.870.093.860.801.690.475.340.05

*   All missing canines and molars considered lost due to caries (2 surfaces counted for every lost canine and 3 surfaces counted for every lost molar).

**   Total d3s includes code 4 (decayed and filled surfaces).

Table G2

Distribution by tooth surface (M=mesial, O=occlusal, D=distal, B=buccal, L=lingual) for "unrestorable decay" (C3), total decay (d3), filled (f) as a % of total d3fs, by Health Board (decay defined as decay into dentine).

Health BoardM-C3O-C3D-C3B-C3L-C3
Argyll & Clyde3.15.75.02.54.0
Ayrshire & Arran2.24.53.93.24.1
Borders2.23.43.42.53.3
Dumfries & Galloway2.53.24.32.63.0
Fife2.73.73.22.53.3
Forth Valley2.35.04.72.73.6
GRA0.71.71.70.81.2
Greater Glasgow1.94.24.12.33.3
Highland0.82.21.81.11.6
Lanarkshire3.35.14.73.54.5
Lothian1.72.52.41.72.1
Orkney0.81.41.81.41.6
Shetland4.06.96.05.06.2
Tayside1.34.02.71.11.8
Western Isles1.33.22.91.42.1
Scotland (Weighted)2.03.83.52.23.0
Health BoardM-dO-dD-dB-dL-d
Argyll & Clyde17.329.418.312.914.4
Ayrshire & Arran15.225.016.414.216.9
Borders12.927.612.912.113.3
Dumfries & Galloway13.428.815.716.021.3
Fife13.328.418.713.720.5
Forth Valley12.930.417.014.418.6
Grampian13.029.316.314.319.1
Greater Glasgow14.926.517.415.318.5
Highland13.026.915.315.618.6
Lanarkshire15.725.517.016.718.8
Lothian14.428.815.312.116.3
Orkney12.024.115.49.913.4
Shetland13.621.113.516.617.7
Tayside15.526.714.815.217.8
Western Isles14.217.412.414.816.8
Scotland (Weighted)14.627.516.514.417.9
Health BoardM-fO-fD-fB-fL-f
Argyll & Clyde0.64.21.10.61.1
Ayrshire & Arran1.16.41.91.01.7
Borders1.99.34.62.33.1
Dumfries & Galloway0.92.41.00.10.5
Fife0.23.41.00.40.4
Forth Valley0.83.31.40.60.6
Grampian0.93.71.21.01.2
Greater Glasgow0.93.71.20.61.0
Highland1.45.61.70.71.2
Lanarkshire0.53.31.10.60.8
Lothian1.56.42.80.81.4
Orkney2.211.95.32.93.0
Shetland1.310.53.31.11.3
Tayside0.95.31.70.71.3
Western Isles2.513.04.32.32.3
Scotland (Weighted)0.94.71.60.81.1

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Appendix H

Oral cleanliness:

Assessment of plaque for 5 year old children

Extract from training notes:

Aim: A simple determination of the presence of visible plaque on the upper and lower anterior segments of 5 year olds.

Codes*:0=teeth appear clean
1=a little plaque visible
2=substantial amount of plaque visible
9= assessment cannot be made (for both segments, if only one segment visible score that

* A probe is not used for this part of the examination. Consider plaque only, ignore recent debris such as small pieces of crisp found in an otherwise clean mouth immediately after a school lunchtime.

Figure H1

Percentage of children in each Health Board recorded as having substantial plaque, a little plaque or no plaque.

Figure H1 Table H1

Mean d3mft and d3t values (appropriately weighted) for children with differing plaque scores.


Plaque assessmentd3mftd3t% males
teeth appear clean2.221.5449%
a little plaque visible3.622.7053%
substantial amount of plaque visible5.184.0755%
All2.932.1351%
Probability*<0.001<0.001<0.001

* Probability from linear association statistical tests

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Appendix I

Maps of d3mft results for Great Britain and Scotland

Figure I1

BASCD UK map showing geographical variation in dental caries experience (d3mft) of 5 year old children, 1993/94

Figure I1

Figure I2

SHBDEP map showing dental caries experience (d3mft) by Health Board for 5 year old children in Scotland for 1995/96

Figure I2

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