1. Adult Dental Health Survey 2009 So does it matter? Impacts Georgios Tsakos On behalf of the ADHS consortium

2. Key questions What do people think about their oral health? What impact do oral conditions have on the quality of life of people? How many people are concerned? How big a concern? Which are the main problems that lead to impacts? Which factors relate to these impacts?

3. Outline Focus on subjective perceptions – main data source: interviewer- administered questionnaire Outcomes: 1.Self-rated health o General health o Dental health 2.Oral Health Related Quality of Life o Oral health Impact Profile (OHIP-14) - frequency o Oral Impacts on Daily Performances (OIDP) - severity Variation by – Demographics – Socioeconomic position – Clinical dental status

4. Self-rated health High levels of reported good or very good health: – 80% for general health and 71% for oral health, but… – Considerable minority with fair/bad/very bad dental health Dental health ratings not affected by being edentate (adaptation? expectations?)… … but general health ratings are: broader importance of good dental health

5. Self-rated health by dental status Worse dental health perceptions for people that have some natural teeth and also denture(s) This is a group that is going to be very common in future cohorts of older people: public health concern?

6. Self-rated health by Occupation Clear gradient in self-rated health (both general and dental) by socioeconomic classification of household among dentate people: – Better perceptions (higher proportion with good or very good ratings) for each higher socioeconomic position (SEP) group

7. Dentate adults: Clinical oral healthPercentage with good / very good … General healthDental health Number of teeth 21 or more8674 Fewer than 216153 Number of sound, untreated teeth 18 or more8877 Fewer than 187663 Number of decayed teeth None8578 One or more7854 Periodontal condition No pockets of 4mm or more8677 Pockets of 4mm or more7863 Excellent oral health (21+ teeth and 18+ sound and untreated teeth, no active decay, no 4mm+ pocketing or attachment loss) Yes9488 No8169 Self-rated health by clinical status Dentate people with healthier mouth report better dental and general health

8. Oral health related quality of life measures: why use them? Beyond clinical measures … into perceptions about how dental health affects quality of life Measures of the extent that health status and conditions disrupt normal social-role functioning and bring about major changes in behaviour (Locker, 1989) Subjective indicators that provide information on the impact of oral conditions on daily life of people OHRQoL measures complement (not substitute) clinical measures

9. Oral health related quality of life measures Oral Health Impact Profile - 14 (OHIP-14) 14 items - 7 dimensions – Functional limitation – Physical pain – Psychological discomfort – Physical disability – Psychological disability – Social disability – Handicap Oral Impacts on Daily Performances (OIDP) 9 activities of daily living – Eating – Speaking – Cleaning teeth or dentures – Going out – Relaxing – Smiling – Carrying out major work or role – Emotional instability – Enjoying social contacts

10. Oral health related quality of life measures Oral Health Impact Profile - 14 (OHIP-14) Frequency – In the last 12 months, have you had trouble PRONOUNCING ANY WORDS because of problems with your teeth, mouth or dentures? (1)....never (2)....hardly ever (3)....occasionally (4)....fairly often (5).... very often Prevalence, number of problems, OHIP-14 score Oral Impacts on Daily Performances (OIDP) Severity – Using a scale from 0 to 5, where 0 is no effect and 5 is a very severe effect, can you tell us what effect DIFFICULTIES EATING caused by your mouth, teeth or false teeth have had on your daily life in the past 12 months? Perceived causes – Which, if any, of the following have caused DIFFICULTIES EATING? Toothache, Loose tooth, Bad position of teeth, Broken / fractured tooth, … Prevalence, extent, OIDP score

11. OHIP-14 dimensions Percentage experiencing problem occasionally or more often… DentateEdentate Functional limitation 612 Physical pain 3033 Psychological discomfort 2015 Physical disability 812 Psychological disability 1410 Social disability 63 Handicap 46 At least one problem 3940 Mean number of problems 1.21.1 Mean total OHIP-14 score 17.4 Frequency of impacts (OHIP-14) Considerable proportion with impacts (39% of dentate and 40% of edentate) No difference in OHIP-14 between dentate and edentate people Most common impacts: physical pain and psychological discomfort Not very frequent, not many problems reported

12. Trends in impacts (OHIP-14) among dentate in England Along with improvement in health, lower levels of oral impacts 51% had experienced impacts occasionally or more often in 1998 and 39% did so in 2009

13. Severity of impacts (OIDP) One third of adults with impacts (33% of dentate and 29% of edentate) Most prevalent impacts: eating and smiling No difference between dentate and edentate people overall, but for specific performances: dentate reported higher prevalence for smiling, cleaning teeth, and relaxing, while edentate had more impacts in relation to speaking

14. Severity of impacts - a closer look In general, impacts did not have severe effects on the daily life of participants… But 15% of dentate and 13% of edentate adults in the general population reported that their dental health had severe negative impacts on their daily life (OIDP rating > 3) Among those that reported at least one oral impact, almost half (46%) reported a score of 3 or higher in the OIDP severity ratings A minority with severe impacts: Who are they? What are their characteristics?

15. Impacts by dental status Worse quality of life (higher proportion with impacts) for dentate people that have some natural teeth and also denture(s) This is a group that is going to be very common in future cohorts of older people: public health concern?

16. Prevalence of impacts by Occupation among dentate Socioeconomic position gradient, with worse quality of life at successively lower levels of household occupation among dentate people Gradient is steeper for more severe impacts Lower socioeconomic position groups at disadvantage

17. Dentate adults: Clinical oral healthPercentage with oral impacts OHIP-14OIDP Number of teeth 21 or more3934 Fewer than 215245 Number of sound, untreated teeth 18 or more3632 Fewer than 184640 Number of decayed teeth None3833 One or more4942 Periodontal condition No pockets of 4mm or more3733 Pockets of 4mm or more4538 Excellent oral health (21+ teeth and 18+ sound and untreated teeth, no active decay, no 4mm+ pocketing or attachment loss) Yes3432 No4236 Impacts by clinical status Impacts were associated with every clinical measure among dentate people: better clinical status - lower levels of impacts

18. Which oral conditions were reported as causes of impacts? Different pattern of causes for different impacts Most common causes for most impacts: 1) Toothache / sensitive tooth / tooth decay, 2) gum problems … Not necessarily so for impacts linked to psychological or social aspects of life (e.g. smiling, social contacts)

19. Conclusions Quite positive general perception of dental health: Vast majority perceived their dental health as good / very good And for the majority of the population, their dental health did not have a negative impact on their life Compared to 1998, improvement in OHIP-14 prevalence However, a considerable proportion experienced impacts OHIP-14: 39% of dentate and 40% of edentate OIDP: 33% of dentate and 29% of edentate In general, impacts were neither very frequent (OHIP-14) nor very severe (OIDP)…

20. Conclusions … but the impacts were severe among the minority that reported them: 46% of those with at least one oral impact reported a score of 3 or higher (scale: 0-5) in the OIDP severity ratings Higher levels of impacts among dentate adults with denture(s): increased importance in future? Among dentate, worse clinical status is linked to more impacts Clear and consistent socioeconomic position gradient, with worse dental health perception and higher levels of impacts at successively lower SEP levels Importance of addressing health inequalities

21. 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