Preventive behaviour and risks to oral health

Barbara Chadwick

Outline:• Data based on

– interviewer-administered questionnaire

– clinical dental examination• Two main themes:

1. Oral Hygieneo Tooth brushing frequencyo Fluoride toothpaste usageo Other methodso Advice

2. Risks to Oral Healtho Smokingo Smoking cessationo Sugar consumptiono Plaque & Calculus

Reported frequency of tooth cleaning of dentate adults by age

AGE Brush x2 or more per day

Brush once per day

Brush less than once per day

Never brush

All % 75 23 2 1

16-24 % 72 24 3 1

25-34 % 76 22 2 0

35-44 % 80 18 1 1

45-54 % 76 22 2 1

55-64 % 73 24 3 1

65-74 % 71 26 2 1

75-84 % 70 27 2 1

85+ % 63 32 4 1

75% of dentate adults report cleaning their teeth twice a day75% of dentate adults report cleaning their teeth twice a day

Reported frequency of tooth cleaning of dentate adults by sex, SEC and dental attendance

Characteristic Brush x2 or more per day

Brush once per day

Brush less than once per day

Never brush

Sex

Men % 67 28 4 1

Women % 82 17 1 0

SEC Household

Managerial % 79 19 1 0

Intermediate % 73 24 2 1

Manual % 68 28 3 1

Attendance

Regular % 80 19 1 0

Occasional % 74 23 2 1

With trouble % 65 30 4 1

Never been % 53 37 6 4

82 % of women compared with 67% of men brush twice a day or more

79 % of adults from managerial and professional occupation households brush twice a day or more compared with 68% from routine and manual occupation households

80% of adults who attend for regular check-up brush at least twice a day compared with 65% who visit a dentist when they have trouble

82 % of women compared with 67% of men brush twice a day or more

79 % of adults from managerial and professional occupation households brush twice a day or more compared with 68% from routine and manual occupation households

80% of adults who attend for regular check-up brush at least twice a day compared with 65% who visit a dentist when they have trouble

Reported brushing frequency dentate adultsEngland 1998-2009

Similar improvements are seen in Wales & Northern Ireland over the same period

Similar improvements are seen in Wales & Northern Ireland over the same period

Fluoride toothpaste usage

• Data not collected previously• Toothpaste brand names coded by interviewer

– high (1,350 to 1,500ppm), – medium (1,000 to 1,350ppm) and – low (550ppm or less)

• 76% dentate adults used high fluoride toothpaste (range 81% age 25-34; 70% 85+)

• Some variation across age groups, older adults more likely to report low or no fluoride toothpaste ( range 3% age 16-34; 16% 85 +)

Other oral hygiene productsProduct % using

Toothbrush/paste only 42

Other product 58

Mouthwash 31

Electric toothbrush 26

Dental Floss 21

Toothpick/woodstick 7

Interspace brush 6

SF chewing gum 3

Denture cleaner 1

Excludes those who report never brushingExcludes those who report never brushing

Characteristic % using other product

Sex

Men 53

Women 61

Country

England 59

Wales 46

Northern Ireland 48

SEC Household

Managerial 66

Intermediate 57

Manual 49

Attendance

Regular 63

Occasional 56

With trouble 47

Never been 24

Use of 3 most popular dental hygiene products by age

Mouthwash is most popular with 16-54 year old adults

Electric toothbrush is more popular in adults aged over 55 years

There are clear difference in floss usage between the sexes:

Mouthwash 30% male : 31% femaleElectric TB 25% male : 27% femaleFloss 16% male : 26% female

Mouthwash is most popular with 16-54 year old adults

Electric toothbrush is more popular in adults aged over 55 years

There are clear difference in floss usage between the sexes:

Mouthwash 30% male : 31% femaleElectric TB 25% male : 27% femaleFloss 16% male : 26% female

Reported use of additional products by dentate adults by characteristics

Characteristic Brush/paste only Other product Mouthwash Electric TB Floss

Sex

Men % 47 53 30 25 16

Women % 39 61 31 27 26

Country

England % 41 59 31 27 22

Wales % 54 46 25 19 16

N Ireland % 52 48 31 14 17

SEC Household

Managerial % 34 66 33 34 28

Intermediate % 43 57 31 25 22

Manual % 51 49 29 18 13

Attendance

Regular %

37 63 31 31 27

Occasional % 43 56 32 25 21

With trouble % 53 47 31 16 11

Never been % 76 24 19 7 0

Frequency brushing

<1 / day % 63 37 23 12 5

1/day % 51 49 26 21 13

2 or more % 39 61 33 28 25

0

10

20

30

40

50

60

70

80

Just toothbrush andtoothpaste

Mouthwash Electric toothbrush Dental floss

Per

cen

tag

e Regular check up

Occasional check up

Only with trouble

Never been to dentist

Reported use products dentate adults England 1978-2009

Mouthwash data not available in 1978Data excludes those who never brushMouthwash data not available in 1978Data excludes those who never brush

Advice on brushing by characteristics of dentate adults

Characteristic % Given advice

All 78

Age

16-24 78

25-34 81

35-44 82

45-54 82

55-64 80

65-74 72

75-84 62

85+ 54

Characteristic % Given advice

Sex

Men 78

Women 78

Country

England 78

Wales 74

Northern Ireland 77

SEC Household

Managerial 84

Intermediate 77

Manual 72

Attendance

Regular 82

Occasional 78

With trouble 70

Denture use

Natural teeth & denture 68

Natural teeth only 79

Overall 78 per cent of adults said that they had been given advice by a dentist or a member of the dental team on cleaning their teeth and/or gums

Overall 78 per cent of adults said that they had been given advice by a dentist or a member of the dental team on cleaning their teeth and/or gums

Dental Hygiene advice 1998-2009

Dentate adults 1998 2009

Percentage given dental hygieneAdvice / information

63 781998• Has a dentist or any of the dental

staff demonstrated to you how to clean your teeth?

• Has a dentist or any of the dental staff given you advice on caring for your gums?

2009• Have you ever been given advice

from a dentist or any of the dental team on cleaning your teeth and/or gums?

Recalled advice on oral hygiene from the dental team has risen.

But measurement differences between the surveys mean data should be viewed with caution.

Recalled advice on oral hygiene from the dental team has risen.

But measurement differences between the surveys mean data should be viewed with caution.

Risks to oral health: Smoking

• Smoking habits included for the first time

• Government surveys harmonised questions used

• All respondents, (dentate & edentate)were asked whether they currently smoked and if not, whether they had ever smoked

• Also asked about advice on giving up smoking provided by the dentist or a member of the dental team?

22 per cent of all adults currently smoked

Marginally more edentate adults smoked compared with dentate adults, 24 per cent compared with 22 per cent

22 per cent of all adults currently smoked

Marginally more edentate adults smoked compared with dentate adults, 24 per cent compared with 22 per cent

Smoking status – dentate adultsCharacteristic PercentageAll 22

Age

16-24 2825-34 3035-44 2545-54 2255-64 1965-74 1175-84 785+ 6

Characteristic PercentageSex

Men 24Women 21Country

England 22Wales 23Northern Ireland 26SEC Household

Managerial 16Intermediate 22Manual 30

Smoking cessation adviceDentate Edentate

Advice or help by dental team at last visit

% %

Yes 9 7

No 57 72

Never smoked 35 22

Total 100 100

• All adults who had visited a dentist in the two years prior to being interviewed were asked if any member of the dental team had given them advice on giving up smoking at their most recent visit.

These figures suggest the dental team are not comfortable delivering advice on smoking.

However those not receiving advice include individuals who are not (and perhaps have never been) smokers.

These figures suggest the dental team are not comfortable delivering advice on smoking.

However those not receiving advice include individuals who are not (and perhaps have never been) smokers.

Risks to oral health: Sugar consumptionProcess• Questions taken from the Heath

Survey for England were included • Adults who reported

– 6+ / week = high sugar user– No report of 6+ = low sugar users.

• Measuring dietary consumption in a cross sectional survey is particularly difficult.

• Data provides a proxy rather than definitive indication of sugar consumption in the general population

Questions1. How often, on average, do you eat a serving of

cakes, biscuits, puddings or pastries? 2. How often, on average, do you eat sweets or

chocolate? 3. How often, on average do you have fizzy drinks,

fruit juice, or soft drinks like squash, excluding diet or sugar-free drinks?

– 6 or more times a week – 3-5 times a week – 1-2 times a week – Less than once a week – Rarely or never

4. Do you usually have sugar in hot drinks like tea and coffee?

– Yes – No – Does not drink hot drinks

5. Has a dentist or member of the dental team ever asked you about the types of food and drink you consume?

6. Have you ever been given advice or help from a dentist or a member of the dental team about the food and drinks you should be consuming?

High sugar consumption and characteristics of dentate adults

Characteristic Percentage

All 50

Age

16-24 60

25-34 52

35-44 47

45-54 42

55-64 45

65-74 49

75-84 61

85+ 65

Sex

Men 53

Women 46

Characteristic Percentage

Country

England 50

Wales 51

Northern Ireland 54

SEC Household

Managerial 50

Intermediate 48

Manual 51

Attendance

Regular 49

Occasional 47

With trouble 53

Never visited a dentist 41

Denture use

Natural teeth & denture 52

Natural teeth only 49

Diet advice:Dentate adults over their lifetimeDiet advice given over lifetime %

Asked about diet and given advice

27

Asked about diet and not given advice

9

Never asked about diet 64

Total 100

• Almost two thirds of dentate adults who have attended a dentist have no recollection of being asked about diet

• While some adults may not actually need advice, it appears that dental teams are less likely to discuss diet than they are oral hygiene measures

Excludes adults who have never been to a dentistExcludes adults who have never been to a dentist

Visible plaque and calculus

Plaque• Reported by tooth

– The proportion of dentate adults with at least one tooth affected

– The mean number of teeth affected

– The proportion of teeth affected averaged over the population

Calculus• Reported by sextant

– 1998 was reported at tooth level

– backward comparison not possible

Presence of visible plaque in dentate adults

Measure Dentate Adults

Amongst all dentate adults

Percentage with visible plaque 66%

Mean number of teeth with visible plaque 6

Mean number of teeth 25.7

Mean percentage of teeth with visible plaque 23%

Amongst those with visible plaque

Mean number of teeth with visible plaque 9

Mean number of teeth 25.6

Mean percentage of teeth with visible plaque 35%

Two thirds of dentate adults have visible plaque.In those with visible plaque a third of teeth are affectedTwo thirds of dentate adults have visible plaque.In those with visible plaque a third of teeth are affected

Distribution of plaque

For dentate adults most plaque prone teeth:Lower jaw;Incisors (26 – 45 % visible plaque)Upper jaw; Second molar tooth (18-19 %)

For dentate adults most plaque prone teeth:Lower jaw;Incisors (26 – 45 % visible plaque)Upper jaw; Second molar tooth (18-19 %)

Visible plaque and characteristics of dentate adults

Characteristic % visible plaque

Mean No teeth

All 66 6.0

Sex

Men 71 6.9

Women 61 5.0

SEC

Managerial 59 4.7

Intermediate 68 6.0

Manual 73 7.4

• No significant differences between age groups

• Men have more plaque than women, and more teeth with plaque

• Socio-economic status is also linked to presence of plaque

Visible plaque and reported lifestyle behaviours of dentate adults

Behaviour % visible plaque Mean No teeth

All 66 6.0

Attendance

Regular 61 4.7

Occasional 67 5.8

With trouble 76 8.4

Time since last visit

<1 year 63 5.0

Between 1-5 years 72 7.3

Over 5 and up to 10 years 82 9.0

>10 years 79 9.9

Frequency of cleaning

Never/less than once 94 13.3

Once a day 71 6.7

Twice a day or more 64 5.4

Smoking status

Current smoker 76 7.8

Ex smoker 64 5.1

Never smoked 64 5.7

Visible plaque in dentate adults 1998 and 2009 (England)

1998 2009

Amongst all dentate adults

Percentage with visible plaque 75% 66%

Mean number of teeth with visible plaque 8.9 5.9

Mean number of teeth 24.9 25.9

Mean percentage of teeth with visible plaque 36% 23%

Figures suggest a decrease in plaque levels over the last decade.However examiners are not calibrated for plaque distribution so caution must be taken when interpreting these figures

Figures suggest a decrease in plaque levels over the last decade.However examiners are not calibrated for plaque distribution so caution must be taken when interpreting these figures

Proportion of calculus by sextant and characteristics of dentate adults

Characteristic

% with calculus

Mean No sextants

All 68 1.8

Sex

Men 72 2.0

Women 65 1.6

SEC

Managerial 62 1.4

Intermediate 79 1.9

Manual 75 2.1

27%

29%

22%14%

64%

33%

Calculus mirrors position of plaque.Like plaque few differences between age but more prevalent in men and manual workers.

Calculus mirrors position of plaque.Like plaque few differences between age but more prevalent in men and manual workers.

Presence of visible plaque and calculus in dentate adults by frequency of cleaning teeth

Calculus and reported lifestyle behaviours of dentate adults

Behaviour % with calculus

Mean No sextants

All 68 1.8

Attendance 1

Regular 64 1.5

Occasional 65 1.7

With trouble 79 2.5

Time since last visit

<1 year 65 1.5

Between 1-5 years 74 2.2

Over 5 and up to 10 years 83 2.6

>10 years 84 3.0

Frequency of cleaning

Never/less than once 89 3.0

Once a day 70 2.0

Twice a day or more 67 1.7

Smoking status

Current smoker 79 2.4

Ex smoker 65 1.6.

Never smoked 66 1.7

Calculus and reported lifestyle behaviours of dentate adults

Behaviour % with calculus

Mean No sextants

% visible plaque

Mean No teeth

All 68 1.8 66 6.0

Attendance 1

Regular 64 1.5 61 4.7

Occasional 65 1.7 67 5.8

With trouble 79 2.5 76 8.4

Time since last visit

<1 year 65 1.5 63 5.0

Between 1-5 years 74 2.2 72 7.3

Over 5 and up to 10 years 83 2.6 82 9.0

>10 years 84 3.0 79 9.9

Frequency of cleaning

Never/less than once 89 3.0 94 13.3

Once a day 70 2.0 71 6.7

Twice a day or more 67 1.7 64 5.4

Smoking status

Current smoker 79 2.4 76 7.8

Ex smoker 65 1.6. 64 5.1

Never smoked 66 1.7 64 5.7

Conclusions………….Oral Hygiene• 75% of dentate adults brush their teeth twice a day• 78% of adults recall advice about oral hygiene from the dental team• However, at examination only 34% of dentate adults were plaque free; while 68%

had calculus in at least one sextant• The oral hygiene message has been taken on board by the majority of adults and

the dental team are involved – but there is still room for improvement in the efficacy of cleaning

Advice on diet and smoking• 9% of dentate and 7% of edentate adults who attended a dentist in the last 2 years

recalled being asked about smoking; • Two thirds of adults said they had never been asked about their diet• Dental teams are also well positioned to provide advice on both diet and smoking

but this survey suggests they are less comfortable providing advice to patients in these areas

Adult Dental Health Survey 2009The NHS Information Centre commissioned the survey, with funding provided by the Department of Health in England, the Welsh Assembly Government and the Department for Social Services and Public Safety in Northern Ireland.

The Office for National Statistics (ONS) was the lead contractor working 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 and University College London