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Preventive behaviour and risks to oral health Barbara Chadwick.

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1 Preventive behaviour and risks to oral health Barbara Chadwick

2 Outline: Data based on – interviewer-administered questionnaire – clinical dental examination Two main themes: 1.Oral Hygiene o Tooth brushing frequency o Fluoride toothpaste usage o Other methods o Advice 2.Risks to Oral Health o Smoking o Smoking cessation o Sugar consumption o Plaque & Calculus

3 Reported frequency of tooth cleaning of dentate adults by age AGEBrush x2 or more per day Brush once per day Brush less than once per day Never brush All% % % % % % % % % % of dentate adults report cleaning their teeth twice a day

4 Reported frequency of tooth cleaning of dentate adults by sex, SEC and dental attendance CharacteristicBrush x2 or more per day Brush once per day Brush less than once per day Never brush Sex Men % Women % SEC Household Managerial % Intermediate % Manual % Attendance Regular % Occasional % With trouble % Never been % % 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

5 Reported brushing frequency dentate adults England Similar improvements are seen in Wales & Northern Ireland over the same period

6 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 +)

7 Other oral hygiene products Product% using Toothbrush/paste only 42 Other product58 Mouthwash31 Electric toothbrush26 Dental Floss21 Toothpick/woodstick7 Interspace brush6 SF chewing gum3 Denture cleaner1 Excludes those who report never brushing Characteristic% using other product Sex Men53 Women61 Country England59 Wales46 Northern Ireland48 SEC Household Managerial66 Intermediate57 Manual49 Attendance Regular63 Occasional56 With trouble47 Never been24

8 Use of 3 most popular dental hygiene products by age Mouthwash is most popular with year old adults Electric toothbrush is more popular in adults aged over 55 years There are clear difference in floss usage between the sexes: Mouthwash30% male : 31% female Electric TB25% male : 27% female Floss16% male : 26% female Mouthwash is most popular with year old adults Electric toothbrush is more popular in adults aged over 55 years There are clear difference in floss usage between the sexes: Mouthwash30% male : 31% female Electric TB25% male : 27% female Floss16% male : 26% female

9 Reported use of additional products by dentate adults by characteristics CharacteristicBrush/paste onlyOther productMouthwashElectric TBFloss Sex Men % Women % Country England % Wales % N Ireland % SEC Household Managerial % Intermediate % Manual % Attendance Regular % Occasional % With trouble % Never been % Frequency brushing <1 / day % /day % or more %

10 Reported use products dentate adults England Mouthwash data not available in 1978 Data excludes those who never brush Mouthwash data not available in 1978 Data excludes those who never brush

11 Advice on brushing by characteristics of dentate adults Characteristic% Given advice All78 Age Characteristic% Given advice Sex Men78 Women78 Country England78 Wales74 Northern Ireland77 SEC Household Managerial84 Intermediate77 Manual72 Attendance Regular82 Occasional78 With trouble70 Denture use Natural teeth & denture68 Natural teeth only79 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

12 Dental Hygiene advice Dentate adults Percentage given dental hygiene Advice / information 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.

13 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

14 Smoking status – dentate adults Characteristic Percentage All 22 Age Characteristic Percentage Sex Men 24 Women 21 Country England 22 Wales 23 Northern Ireland 26 SEC Household Managerial 16 Intermediate 22 Manual 30

15 Smoking cessation advice DentateEdentate Advice or help by dental team at last visit % Yes97 No5772 Never smoked3522 Total100 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.

16 Risks to oral health: Sugar consumption Process 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 Questions 1.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?

17 High sugar consumption and characteristics of dentate adults CharacteristicPercentage All50 Age Sex Men53 Women46 CharacteristicPercentage Country England50 Wales51 Northern Ireland54 SEC Household Managerial50 Intermediate48 Manual51 Attendance Regular49 Occasional47 With trouble53 Never visited a dentist41 Denture use Natural teeth & denture52 Natural teeth only49

18 Diet advice: Dentate adults over their lifetime Diet advice given over lifetime% Asked about diet and given advice 27 Asked about diet and not given advice 9 Never asked about diet64 Total100 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 dentist

19 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

20 Presence of visible plaque in dentate adults MeasureDentate Adults Amongst all dentate adults Percentage with visible plaque66% Mean number of teeth with visible plaque6 Mean number of teeth25.7 Mean percentage of teeth with visible plaque23% Amongst those with visible plaque Mean number of teeth with visible plaque9 Mean number of teeth25.6 Mean percentage of teeth with visible plaque35% Two thirds of dentate adults have visible plaque. In those with visible plaque a third of teeth are affected Two thirds of dentate adults have visible plaque. In those with visible plaque a third of teeth are affected

21 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 %)

22 Visible plaque and characteristics of dentate adults Characteristic% visible plaque Mean N o teeth All666.0 Sex Men716.9 Women615.0 SEC Managerial594.7 Intermediate686.0 Manual737.4 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

23 Visible plaque and reported lifestyle behaviours of dentate adults Behaviour% visible plaqueMean No teeth All666.0 Attendance Regular614.7 Occasional675.8 With trouble768.4 Time since last visit <1 year635.0 Between 1-5 years727.3 Over 5 and up to 10 years829.0 >10 years799.9 Frequency of cleaning Never/less than once Once a day716.7 Twice a day or more645.4 Smoking status Current smoker767.8 Ex smoker645.1 Never smoked645.7

24 Visible plaque in dentate adults 1998 and 2009 (England) Amongst all dentate adults Percentage with visible plaque75%66% Mean number of teeth with visible plaque Mean number of teeth Mean percentage of teeth with visible plaque36%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

25 Proportion of calculus by sextant and characteristics of dentate adults Characteristic% with calculus Mean N o sextants All681.8 Sex Men722.0 Women651.6 SEC Managerial621.4 Intermediate791.9 Manual % 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.

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

27 Calculus and reported lifestyle behaviours of dentate adults Behaviour% with calculus Mean No sextants All681.8 Attendance1 Regular641.5 Occasional651.7 With trouble792.5 Time since last visit <1 year651.5 Between 1-5 years742.2 Over 5 and up to 10 years832.6 >10 years843.0 Frequency of cleaning Never/less than once893.0 Once a day702.0 Twice a day or more671.7 Smoking status Current smoker792.4 Ex smoker Never smoked661.7

28 Calculus and reported lifestyle behaviours of dentate adults Behaviour% with calculus Mean No sextants % visible plaque Mean No teeth All Attendance1 Regular Occasional With trouble Time since last visit <1 year Between 1-5 years Over 5 and up to 10 years >10 years Frequency of cleaning Never/less than once Once a day Twice a day or more Smoking status Current smoker Ex smoker Never smoked

29 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

30 Adult Dental Health Survey 2009 The 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


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