Question 1

Answer BOTH parts.

1. (a) The DMF index has been used in dental epidemiology since the late 1930s,
so its advantages must outweigh its disadvantages. Please write a paragraph
on each of those aspects. (10 marks)
2. (b) Summarise the substantial contributions that the Dunedin Study has
made to our knowledge of the natural history of dental caries. (15 marks)

1a) The DMF index is the traditional way of scoring teeth, which is widely used in dentistry
and a wide range of dental related studies. The letters correspond to ‘decayed (D)’, ‘missing
(M)’ or filled (F), with the index system only affecting teeth which have dental caries present
on either the tooth or the surfaces. The DMF index can be split into DMFT or DMFS which is
either the number of teeth that have caries (DMFT) or the number of surfaces of teeth
which have caries present on them (DMFS). The advantages of the DMF index includes its
substantial time in use and the wide use of it in this time, the ability to be able to sync
radiography with it and the reliability and validity of it as well. The DMF index has been in
continuous use for around 80 years and has still been in use as no other measure of caries
has overridden it. This is a massive advantage for this system as it proves the effectiveness
that its use has been. Radiography can also be used with the DMF system to identify carious
lesions on either the tooth surfaces, or the teeth themselves. This is because carious lesions
appear a more opaque colour on radiographic images. These allow the DMF index to be
valid, reliable and easy to use for dental practitioners. Some disadvantages to this indexing
system can be the reasons of a missing tooth, doesn’t account for the teeth that are at risk
of caries as well as it only covering the cumulative amount of caries. In the DMF system,
missing teeth are marked as missing. This can be misleading as the tooth can have a wide
range of reasons as to why it has been extracted, including orthodontic reasons, carious
lesions or potential trauma that has occurred leading to tooth removal. In an oral cavity
suffering carious lesions, there can also be a range of teeth that are in the early stages of
caries, yet have no proceeded to be diagnosed. The DMF system does not account for tooth
surface carious lesions until they are decayed, furthermore to this, the index only covers the
total count of caries while not tracking any of their progress, just their presence.

2b) The Dunedin Study was an observational study carried out on 1073 participants born in
1972/73 to track the social, psychological and physical health of these participants. The
study investigated information about dental caries ranging from ages from childhood to
adulthood, with the results showing data that is substantial to our understanding of caries
progression. Data from the study explained how the caries rate remains at a constant as the
participants grew older and continuously had check-ups. This proves that caries is a disease
that everyone is susceptible to and that the only way to prevent caries is through
continuous use of prevention methods to slow down the progression of caries. A factor that
could lead to this is also the routine attendance of the participants of the study, as this
thoroughly dropped as participants got older with age and their fees were no longer state
provided or funded. Another finding of this study was that the carious lesions in late
adolescence lead to bone loss, and that it doesn’t occur earlier. This can be accounted for as
bone loss takes time for carious lesions to demineralise, as well as the transition from
deciduous to permanent teeth throughout the adolescent years. This is significant to our
knowledge of caries as it means that adolescent oral health care is vital and that it can affect
our prevalence of carious tooth loss. Another finding of significance is that a risk factor for
permanent dentition caries is the presence of early childhood caries. Along with the
aforementioned idea, this always proves the importance of childhood oral health care on
the future oral health of young patients, while also contributing to our knowledge of this
multifactorial diseases’ epidemiology from the transition of dentitions. The last finding
regarding dental caries in the Dunedin Study show the susceptibility of patients for root
surface caries is higher when they have high rates of coronal caries. This is a very significant
finding as it can allow dental practitioners to be aware of how these caries progress and
how they can further plan to prevent these. It is also important as patients who do have a
high rate of coronal caries can be frequently assessed for the development of root surface
caries, which can be much more problematic for the patient. In conclusion, the findings of
the Dunedin Study show us about the progression of dental caries from childhood to
adulthood, a risk factor or root surface caries and permanent dentition caries as well as the
development of tooth loss in late adolescence.