The Orthodontic Condition of Children 2003

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The Orthodontic Condition of Children 2003

• I.G. Chestnutt

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Orthodontics

• Orthodontics is the branch of dentistry concerned
  with the growth of the face, development of the
  occlusion and the prevention and correction of
  occlusal anomalies

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Orthodontic expenditure

• In excess of 133,000,000 spent on orthodontic
  Tx in those aged lt18 years in England and Wales
  Year ending March 2004
• Average treatment costs
• Self-employed orthodontists 774
• Orthodontists in hospital clinics 890
• Orthodontists in community clinics 519

(DBP 2004)
(Richmond et al. 2004)
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Expenditure on GDS, England and Wales 2001/02
(redrawn from Audit Commission 2002 based on
DPB data)
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Orthodontic Condition CDH Survey 2003 -
Methodology
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Recording orthodontic condition
5 years
8 years
12 years
15 years
x
x
Clinical examination
Postal questionnaire
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Recording orthodontic condition clinical
examination
At age 12 and 15
Wearing an appliance
Not wearing an appliance
History of appliance wear
Type of appliance
Simplified Index of Orthodontic Treatment Need
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Simplified (Modified) Index of Orthodontic
Treatment Need

• Two Components
• Aesthetic Component
• Dental Health Component

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SIOTN Aesthetic Component (AC)

• Appearance of anterior teeth, judged by examining
  dentist
• Graded 1-10
• Grades 8-10 regarded as in definite need of
  treatment

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SIOTN Dental Health Component (DHC)
Missing teeth
Overjet
Crossbite
Displacement of contact points
Overbite
IOTN Grades 1-5 SIOTN Need (Grades 45)
No need (Grades 1-3) i.e. Borderline incorporate
with no need
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Treatment need

• Subjects can therefore be in need of treatment
• On aesthetic grounds alone
• On dental health grounds alone
• On both aesthetic and dental health grounds

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Orthodontic condition questionnaire

• Views sought on whether
• child had crooked or protruding teeth
• child needed orthodontic treatment
• experience of orthodontic treatment

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Findings
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Orthodontic condition among 12 and 15-year-olds
by sex (United Kingdom 2003)
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Orthodontic condition among 12 and 15-year-olds
by sex (United Kingdom 2003)
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Orthodontic condition among 12 and 15-year-olds
by sex (United Kingdom 2003)
At age 12, little difference in treatment need,
slightly more girls undergoing treatment
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Orthodontic condition among 12 and 15-year-olds
by sex (United Kingdom 2003)
By age 15, 21 of children still in need of
treatment, need is significantly greater in boys
than in girls
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Orthodontic condition among 12 and 15-year-olds
by school deprivation status (United Kingdom
2003)
19
Visual assessment of attractiveness of teeth at
age 12 and 15 years in those not undergoing
orthodontic treatment at the time of the survey
(United Kingdom. 2003)
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Orthodontic condition on dental health grounds at
age 12 and 15 years in those not already
undergoing orthodontic treatment (United Kingdom
2003)
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Trends in current and past orthodontic appliance
wear among 12 and 15 year-olds
Current or past appliance wear
Year
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Types of orthodontic appliance
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Types of orthodontic appliance worn by 12
year-old children wearing an appliance at the
time of the survey
of appliances
Year
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Types of orthodontic appliance worn by 15
year-old children wearing an appliance at the
time of the survey
of appliances
Year
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Findings from the postal questionnaire
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Attitudes to the appearance of the teeth in
children not undergoing orthodontic treatment (12
and 15 year-olds United Kingdom 2003)
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Views on the need for orthodontic treatment in
children not undergoing orthodontic treatment
(12 and 15 year-olds United Kingdom 2003)
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Perceived need vs need as assessed by SIOTN (12
and 15 year-olds United Kingdom)
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In summary

• Just under one third of 15 year olds were either
  wearing or had worn an orthodontic appliance
• This is little changed since 1993
• A significantly greater proportion of appliances
  were of the fixed variety
• One in five 15 year-olds were judged in need of
  orthodontic treatment
• Discrepancies were apparent between perceived
  need and need as assessed by SIOTN.

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Periodontal and non carious tooth conditions

• Barbara Chadwick

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Periodontal condition

• Gingival inflammation
• Plaque
• Calculus
• Non carious tooth conditions
• Tooth surface loss (TSL)
• Enamel opacities
• Accidental damage

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Periodontal health I

• All children visually assessment in sextants for
• Gingival health
• Plaque
• Calculus

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Periodontal health II

• 15 year olds only examined using a periodontal
  probe for gingival bleeding around 6 index teeth
• Periodontal pocketing was not measured
• Assessment is difficult without an invasive
  examination
• Previous surveys do not show pocketing to be
  significant health problem in this age group
• Questionnaire data on oral healthcare is
  available for 3342 subjects

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Proportion of children with gingival inflammation
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Gingival inflammation and sex
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Proportion of children with plaque
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Proportion of children with calculus
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Proportion of children who report brushing teeth
twice daily (questionnaire)
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Visual assessment of gingivae and brushing twice
daily
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Gingivitis amongst 15-year-olds by tooth
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Proportion of 15-year-olds with gingivitis by
reported brushing
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Periodontal health

• Overall childrens mouths are dirtier in 2003
• No criteria change
• ?Examiners more critical
• ?Less acidic oral environment is conducive to
  calculus formation
• The message to brush twice a day has been
  received, but does not appear to make an impact
  in the mouth overall
• There is evidence that brushing twice or more a
  day leads to less gingivitis at age 15
• OHI remains a priority in children

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Tooth surface loss (TSL)

• Reported as erosion in 1993
• TSL used in 2003 multfactoral aetiology
• Difficult to measure
• Professional and public concern raised in the
  decade since the report

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TSL 2003

• All children in the survey
• Upper incisors (buccal and lingual)
• First permanent molars (occlusal)
• Good examiner agreement for dentine involvement

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Proportion of 5 year olds with TSL on primary
incisors
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TSL permanent teeth
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TSL primary teeth

• Half of 5 year olds have TSL palatally
• 22 have dentine exposed

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TSL permanent incisors

• TSL increases with age TSL ? palatal age 15
• Dentine involvement limited (1 age 8, 5 age 15)

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TSL permanent molars

• 22 of first molars have show TSL at 15
• 4 have TSL into dentine

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TSL

• Results suggest an upward trend, particularly for
  permanent teeth
• Few children had extensive dentine exposure in
  permanent teeth, but the condition is
  irreversible
• Do children with TSL in primary teeth go on to
  present with TSL in the permanent dentition?
• Results show that this is a common problem and
  the General Dental Practitioner has the pivotal
  role in early detection and prevention

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Enamel opacities

• First measure in the 1993 CDH survey
• Developmental Defects of Enamel (DDE) Index
  (Thylstrup Fejerskov 1978)
• Recognises three types of opacity alone and in
  combination

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Enamel opacities - demarcated
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Enamel opacities - diffuse
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Enamel opacities -hypoplasia
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Enamel opacities

• 12 year old children only
• 43211234 examined
• DDE Index is not specific for fluorosis so 2003
  includes
• Symmetry of diffuse defects
• Severity of diffuse defects
• All symmetrical diffuse defects compared to a
  standardised index photograph (TF 2)
• (Hawley et al 1996)

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Index photograph (Thylstrup Fejerskov 1978
score 2)
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Percentage of children with opacities at age 12
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Diffuse defects considered for symmetry and
severity
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Symmetry and severity diffuse defects
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Enamel opacities

• 34 examined 12 year olds in UK had an enamel
  opacity on 1 or more teeth
• 20 had diffuse defects, of which two thirds were
  symmetrical

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Enamel opacities

• 34 examined 12 year olds in UK had an enamel
  opacity on 1 or more teeth
• 20 had diffuse defects, of which two thirds were
  symmetrical
• Only 1 of children had diffuse defects above the
  threshold level

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Accidental damage to teeth

• Permanent incisors only
• Criteria unchanged
• Single diagnosis per tooth

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Accidental damage to permanent teeth in UK by age
and sex
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Rate of accidental damage by age 2003
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Proportion of accidental damage treated
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Accidental damage to teeth

• Since 1983 proportion of damage has decreased by
  at least half in all age groups, most marked in
  12 year old boys
• ? Some decrease from use of mouth guards
• ? Children are exercising less
• Majority of fractured incisors remain untreated
• This is appropriate for most fractures in enamel
• It is not appropriate for fractures into dentine
• (50 suffer pulp necrosis left untreated Ravn
  1981, Al Nahan et al 1995)

67
Periodontal Non carious toothcondition condi
tions