Measuring Other Conditions in Oral Epidemiology

Till now we know how to measure dental caries, periodontal disease, and dental fluorosis. Weve other conditions in epidemiology need to be measured like: Malocclusion, Oral cancers, Clift lip and palate.

Malocclusion

Malocclusion: when the teeth in malposition or relationship between upper and lower teeth is abnormal. But Malocclusion is a difficult entity to define because individuals and cultures vary widely in perceptions of what constitutes a malocclusion problem so there is a difficulty in defining malocclusion so it differs from one to another it depends on culture, individual perception.

Because of that weve many indexes to measure malocclusion: Angles classification: it classifies teeth to 3 classes, class 1,2,3 Class 1: upper and lower come into normal position (its normal occlusion). Class 2: upper teeth come anterior to lower teeth. Class3: lower anterior to the upper. o Angles classification may still be useful in treat ment planning but its of no use in epidemiology because it is a nominal categorization.

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Most other indexes suffer from the limitation that they record specific conditions like: Overbite: the upper teeth will be 1mm above lower teeth, when become more than 1mm its called overbite. Overjet: the horizontal distance between upper and lower anterior teeth which will be 1mm, more than 1mm is called overjet. Crossbite: cusps when meet cusps the upper teeth will be outside the fossae of lower teeth so the upper crossing the lower or the reverse. Openbite: when closes the mouth there is a space between upper and lower. Midline shifts: central incisor tilted 4mm or more to right or left.

2- Malalignment index: assesses rotation and tooth displacement. 3- Occlusal feature index: records crowding, cuspal interdigitation, and vertical and horizontal overbite. 4- Handicapping Labio-Lingual Deviations (HLD) Index it was applied to assess treatment needs for a public orthodontic program in New York State. 5- Treatment Priority Index (TPI): developed by Grainger for assessing treatment needs, was used once, but only once, in a national study of orthodontic needs of children in USA. 6- Occlusal Index(OI):it measures 9 characteristics: dental age molar relation overbite overjet. posterior crossbite. posterior open bite. tooth displacement. midline relations. missing permanent maxillary incisors.

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7- Index of Orthodontic Treatment Need (IOTN): its the same as CPITN introduced in 1989 combines both a functional and an esthetic measure. Functional occlusion is categorized into five different grades, whereas the esthetic measure uses a 10-point ordinal scale that allows the individual to determine his own esthetic perception of the dentition.

8- Peer Assessment Rating (PAR) index: is designed to capture all the occlusal anomalies that might be found in malocclusion in a single score. It equals occlusal index in reliability. 9- Index of Complexity, Outcome, and Need (ICON): introduced in the new millennium, it correlates well with patients' perceptions of esthetics, speech, function, and need for treatment. The Federation Dentaire Internationale(FDI): attempted to develop an internationally accepted index and simplified method of determining malocclusion, but it was unsuccessful. The complexities of malocclusion, and the frustrations that have grown up with the inadequacies of these indexes, have led many researchers to believe that functional maloc clusion is virtually immeasurable for epidemiologic purposes. Now the Orthodontic indexes have changed from assessing function to assess aesthetic and its effect on the individual's social and psychological well-being. one of those indexes is: The Dental Aesthetic Index (DAI): it gives 10 pictures to different smiles and orders them from worst to the most beautiful The IOTN also includes an esthetic component measured on a 10-point ordinal scale.

o The World Health Organization, suggests using DAI criteria to record malocclusion in the following categories:
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 Missing incisor, canine, and bicuspid teeth. Incisal crowding in the maxillary and mandibular anterior segments . Spacing in the maxillary and mandibular anterior segments . Diastema(space) between the two maxillary central incisors. Largest irregularity in the front four maxillary anterior incisors (rotations or displacement from normal alignment). Largest irregularity in the front four mandibular anterior incisors . Anterior maxillary and mandibular overjet. Vertical anterior open bite. Anteroposterior molar relation.

ORAL CANCER
We said that rare conditions are measured by proportions or rates. The difference between proportion and rate that in proportion doesnt include time but rate does. Weve some indexes to measure oral cancer:

Age-adjusted rate of years of life lost from oral cancer: each age has specific rate, like if someone is diagnosed today with oral cancer how many years (s)he will live after this diagnosis, for example dropped from 23.1 per 100,000 population in 1970 to 19.9 per 100,000 in 1985.

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 Five-year survival rates: how many subjects(patients) survive beyond 5 years, for example a 5-year survival rate of 67%, means that 67% of persons in whom the condition was diagnosed 5 years earlier are still alive.

Cleft lip and palate

Since cleft lip and palate are rare conditions we deal with them like oral cancer so we can use proportion, about 1 infant in 700 births exhibits this condition.

Any other rare conditions we can use proportion or rate to measure them.

ORAL HEALTH AND QUALITY OF LIFE

In 2000 they started thinking about quality of life, so oral health has impact on quality of life so people can function , do their jobs normally and dont suffer from pain.

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So they studied the impact of oral health on social, psychological life of people.

There are ways to measure these problems and attempt to improve them: The Oral Health Impact Profile (OHIP) : its a questionnaire was 49 questions now its about 14, it asks patients specific questions these questions are related to the impact of teeth health on life quality so it measures the social impact of oral conditions as perceived by the individual and was derived initially from statements given by dental patients in interviews. General Oral Health Assessment Index (GOHAI): originally used for geriatric so its developed from Geriatric Oral Health Assessment Index this is used with elderly in nursing home because theyve the most social distress. This index is 12 item scale that assesses physical functions, psychosocial functions, and pain or discomfort.

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 This lecture is lecture 9 with p art from lecture 10 because its the same subject in the slides.

THE END

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