Public Policy Options for Better Dental Health Report of a Study (1980) / Chapter Skim
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Epidemiology and PRevention of Dental Diseases
Epidemiology and PRevention of Dental Diseases
Pages 27-46
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From page 27... ...
Emphasis is placed on the prevention of caries and periodontal disease because control of the amount and severity of these two major bacteria-related conditions will greatly affect oral health. Malocclusion is also analyzed because it can seriously affect child growth and development in its severe or handicapping forms.
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From page 28... ...
Sucrose may have a special role because some oral bacteria act on sucrose to produce sticky polysaccharides, which in turn enable the acid-producing bacteria to adhere to the surface of the teeth in a film known as dental plaque. Epidemiology Dental caries is the most common dental disease in the United States and is the primary cause of tooth loss through young adulthood: by age 35, the average American has lost five teeth and has 11 more attacked by caries 106/.
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From page 29... ...
Male Female Male Female Total 1.7 0.7 0.1 0.8 6 .2 .3 .1 .1 .0 .15 .1 .1 7 .5 .6 .3 .4 .1 .0 .1 .2 8 1.3 1.2 .6 .6 .1 .0 .6 .6 9 1.9 2.4 1.0 .9 .3 .1 .7 1.4 10 2.5 2.5 .9 .9 .2 .2 1.4 1.5 11 2.6 3.1 1.1 1.1 .4 .3 1.1 1.7 . Source: Health and Nutrition Examination Survey (HARES)
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From page 30... ...
AVERAGE NUMBER OF DECAYED, MISSING AND FILLED TEETH OF DENTULOUS ADULTS, BY AGE AND SEX 1971-74 Age Total DMF Decayed Missing Filled Group Male Female Male Female Male Female Male Female Total 16.9 1.4 7.4 8.1 18-24 10.5 11.0 2.2 1.9 1.7 1.8 6.6 7.3 25-34 14.9 15.8 1.8 1.7 4.1 4.9 9.0 9.2 35-44 18.4 20.0 1.2 1.1 8.4 9.9 8.8 9.2 45-54 19.2 20.5 1.0 0.9 9.9 11.1 8.3 8.5 55-64 20.7 21.5 1.0 0.8 12.4 12.6 7.3 8.1 65-74 21.8 22.5 0.7 0.5 15.6 14.8 5.5 7.2 Source: Health and Nutrition Examination Survey (HADES) , National Center for Health Statistics 113/.
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From page 31... ...
Prevention Several preventive strategies for dental caries are available. These include plaque removal and diet modification and the use of fluorides and tooth sealants.
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From page 32... ...
The fluoridation of school water supplies is effective in rural communities that lack a central water supply. But because children do not attend school until some of their permanent teeth are partially or fully mineralized, the benefits of school water fluoridation are less than for community fluoridation.
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From page 33... ...
Table 14. ESTIMATED ANNUAL COST-BENEFIT RATIOS OF SYSTEMIC FLUORIDES a/ Estimated Cost percent caries Cost per Saving per benefit Method reduction capita capita ratio b/ Community Water Supply Fluoridation 50 $0.20 $10.00 1:50 School Water Fluoridation 40 1.50 8.00 1:5.3 Fluoride Tablets Distributed at School 35 0.40 7.00 1:17.5 a/ Estimates represent maximum benefits, which would not be attained until program has been operating for more than 12 years.
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From page 34... ...
Weekly fluoride mouthrinsing has proved to be an effective method of self-application when carried out in schools. More than 20 largescale clinical trials have shown that frequent mouthrinsing with diluted fluoride solutions inhibits dental caries 138/.
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From page 35... ...
25 to 40 2.60 to 4.40 Annual professional . application or gel in preformed trays 40 4.40 Toothbrush~ng at home 20 10.00 Daily self-application of gel in custom trays 80 21.30 Source: University of Michigan Workshop on Caries Prevention, 1978 147/ Professionally administered fluoride treatments usually consist of a prophylaxis followed by exposure to a fluoride solution or gel for several minutes.
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From page 36... ...
It is unrealistic to attempt to estimate a costbenefit ratio, but this method might be cost-effective if performed by trained auxiliaries rather than dentists, and if done during the same visit as other preventive procedures. Plaque removal Theoretically, the regular removal of plaque should decrease dental caries, because the presence of plaque is necessary to initiate carious lesions.
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From page 37... ...
In a recent symposium on caries prevention, three public health approaches to diet modification were suggested 168/.
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From page 38... ...
Etiology The initiating factor for periodontal diseases is similar to that for dental caries: bacterial colonizations in dental plaque 171/. Although it is not known which of the many organisms in the mouth are responsible for the various forms of periodontal disease, a number of studies have found a direct relationship between the amount of bacterial plaque on teeth and the severity of gingivitis 172-175/.
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From page 39... ...
These data were obtained in the 1971-74 Health and Nutrition Examination Survey 216/ conducted by the National Center for Health Statistics. Epidemiology The incidence of periodontal diseases varies most noticeably with age and oral hygiene 197/.
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From page 40... ...
Extensive surgical therapy for advanced periodontal diseases is usually performed on patients who can maintain their oral hygiene and who understand the disease process which they are being motivated to control. Several studies in which comparisons were made between conservative treatment (curettage)
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From page 41... ...
Prevention Plaque bacteria play a major role in the etiology of both dental caries and periodontal diseases. Since natural mechanisms do not adequately clean teeth, a combination of professional cleaning and personal oral hygiene practices (toothbrushing, flossing, water pressure devices and gingival stimulators)
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From page 42... ...
However, reliance on individual behavior alone to control the bacterial plaque associated with periodontal diseases has not been shown to be effective. Therefore supportive professional attention to remove calcified plaque and reinforce personal oral hygiene habits seem to be necessary components of a successful program to prevent periodontal diseases.
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From page 43... ...
Epidemiology The Health Examination Survey indicated that orthodontic diagnosis, which includes evaluation of facial proportions and the relation of teeth to the underlying bone structure, is needed for approximately 2.5 million children and 10 million youths (about one out of every two youths in the U.S.) who have Treatment Priority Index (TPI)
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From page 44... ...
The report, citing the National Center for Health Statistics, finds that an additional nine percent have a handicapping orthodontic condition for which treatment is "highly desirable." Treatment The treatment of malocclusion is accomplished by a variety of minor and major tooth movement techniques. The objective of treatment, which can require up to 24 months, is to move the teeth into more functionally and esthetically acceptable alignment and occlusion.
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From page 45... ...
Treatment early in life is essential to improved oral health during adulthood. Periodontal disease is most strongly associated with the presence of bacterial plaque due to poor oral hygiene and with increasing age, probably because long-term chronic irritation from the plaque eventually breaks down the periodontal tissues.
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From page 46... ...
A variety of cost-benefit analyses suggest that several of the fluoride strategies are highly cost-effective, providing the basis for the committee's recommendation of a foundation of community fluoridation and preventive care as essential to improvement of dental health. Analyses of dental caries, periodontal diseases, and malocclusions presented in this chapter underlie the recommendations relating to preventive services.
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