Complexity and the Future

1. Complexity and the Future Elizabeth T Treasure Professor of Dental Public Health Cardiff University On behalf of the ADH Consortium

2. ADHS E,W, & NI: Collection of logos and Adult Dental Health Survey 2009 The NHS Information Centre and ONS worked 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 • University College London

3. Objectives • Present the occurrence of restorative care in the population • Describe the complexity of conditions with in the population and discuss risk factors

4. Fillings • 84% had at least one filled tooth • And - for those with a filling • 7.2 teeth affected • 15.7 surfaces • 26% had secondary decay or an unsound restoration • 97% of those aged 45-54 years had at least one filled tooth

5. Fillings • More teeth and more fillings in those who: • Report attending more frequently • Report attending more recently • Report more toothbrushing • In Wales and Northern Ireland • With increasing age • In manual occupational classes

6. Restored teeth and surfaces as a percentage of natural teeth and surface by age

7. Dentures • Almost 20% used dentures • 6% edentate and used full dentures • 13% dentures and natural teeth • Reducing since 1998 (19%)

8. Use of dentures by age

9. Mean number of restored, otherwise sound teeth by age, England 1978-2009

10. Artificial Crowns • 37% had at least one crown • 16-24 years 5% • 55-74 years 55% - 59% • For those with crowns: average of 3 per person (similar to ’98) • 47.6 million crowns across the three countries

11. Bridges • 7% had a bridge • 3% aged 16-44 • 14% of those aged 55 to 74 • More common in regular attenders • Increasing use of bridges since ‘98

12. Implants • 1% had an implant • 0.5% of those aged 25 to 34 years • 2% of those aged over 65 • 2% in intermediate occupations • 1% in professional and manual • (First time we’ve measured this)

13. Development of complexity measure • Some people have a single condition which requires ‘complex’ treatment • Others have a number of conditions • On their own each condition may be ‘simple’ • In combination they may be ‘complex’ • The data I will present is not a score but rather a count

14. Top quintile of restored surfaces (32+ restored) Top quintile for crowns (3 or more) Having any denture, crown or implant Having one or more sextant with pocket of 6mm or more or LOA of 9mm or more Having any active decay of tooth or root Being in the top quintile for active decay (8 or more surfaces) PUFA score greater than 0 or an unrestorable tooth At least one OHIP indicator very or fairly often in last 12 months Indicators of complexity

15. Prevalence of complexity: individual conditions

16. Complexity in the population • 37% had no measure of complexity • 27% had one measure of complexity • 19% had three or more measures • Approx. 7.7 million people

17. Dental health and complexity 3+

18. Dental Health and complexity 5+ by age

19. Complexity 4+

20. Complexity 5+

21. Estimated odds ratio for a complexity score of 5 or more

22. Estimated Odds ratio for a complexity score of 5+

23. Factors associated with complexity • Increasing age • Less frequent reporting of dental attendance • Less frequent reporting of tooth cleaning • Presence of plaque • Current smoker • NB difference to fillings

24. Conclusions • Restorations remain very common in all age groups • There are changing patterns in the provision of restorations • Few dentures, more bridges and implants • A method of combining complex conditions is presented • Multiple conditions are present in approximately 20%