5.14.2 Data sources
Data were collected from national, regional or local oral
health surveys or in specific communities including sample registration
systems, surveillance systems, national survey data, and literature review.
Major sources of information are the WHO Global Oral Data Bank (WHO,
2008), the CECDO Database (CECDO, 2008), ministries of health and scientific
reports from population studies on oral health carried out in various
countries. A total of more than 1,890 scientifically validated studies are
contained in the WHO database but the fact that these surveys have more local
or regional rather than national representativeness somewhat limits their
impact. Oral health surveys were based on nationally representative
samples. The data stored in the databank are updated regularly and the WHO GODB
is currently linked with new information’s systems for surveillance of chronic
disease and risk factors (Petersen et al, 2005). Few countries in
Western Europe have established a data collection system at the national level:
only United Kingdom has secular epidemiological data on the prevalence of
caries in young children, adolescents and adults (Bourgeois, 2004). In Scandinavia, oral health information’s systems are an integral part of health services system.
In Denmark, an advanced computer system has been established for children
whereas surveillance of the oral health of the adult population is based on
integrated chronic questionnaire schemes. In France, Germany, Spain, a series of surveys have been conducted on random sample of children, adolescents,
adults age group and elderly. The tradition of surveillance is less developed
in southern and Eastern Europe but progress have been established recently in Hungary, Poland and Portugal.
The indicators, issue from the EGOHID I project
(www.egohid.eu), identified for this document are:
a. Decay Experience in Permanent
Molars in Children
Mean number of decayed, missing and filled
permanent molars present per children at 6 and 12 years of age.
Numerator: Total number of decayed (specify diagnostic threshold),
missing and filled permanent molars present per children at 6 and 12 years of
Denominator: Total number of children at 6 and 12 years of age
b. Dental Contact within the
Previous Twelve Months
Proportion of population aged 2 and over who
visited the dentist or dental clinic within the past year.
Numerator: Number of subjects aged 2 and over who visited a
dentist or dental clinic within the past years.
Denominator: Total number of subjects aged 2 and over surveyed.
The question to be asked should be: When
did you last visit a dental professional about your teeth, dentures or gums?
c. Periodontal Health Assessment
Proportion of population in the age group
12, 15, 18 and 35-44 and 65-74 years in the four categories: healthy
periodontium, gingivitis only, periodontal pockets of from 4mm - 6 mm, periodontal pockets of 6 mm or deeper.
Numerator: Number of individuals in the age group 12, 15, 18 and
35-74 years in each of the four categories.
Denominator: Number of individuals in the age group 12, 15, 18 and
35-74 years examined.
Only bleeding status is recommended at age
12 and 15.
d. Edentulous Prevalence
Proportion of adult population aged more
than 35 years who have lost all their natural teeth.
Numerator: Number of adults aged more than 35 years who have lost
all their natural teeth.
Denominator: Number of adults surveyed.
e. Dentists and Other Oral Care
The number and rates (per 100,000
population) of active dentists, dental hygienists, oral health therapists and
clinical dental technicians.
Numerator: Number of active dentists and other oral care clinical
providers per 100,000 population.
Denominator: Mid-year population.
The international epidemiological monitoring of oral
health is a relatively recent initiative. Many countries traditionally recorded
the number and type de services provided i.e. the number of teeth extracted and
number of filled of dental fillings, but not the outcomes, i.e. whether
interventions contributed to health or not. Some western European countries
have established outcome-oriented information’s systems, but neglected the
processes. The development of more comprehensive data systems for improving the
quality of oral health care and systems is encouraged.
Comparisons of the global frequency and
distribution of dental caries are complicated by diagnostic criteria that
differ from study to study, but a fall in the prevalence and severity of caries
in permanent teeth has been seen in many developed countries over recent
decades. Also, the rate of progression of the disease slows down with increased
age. The disease is mainly found in specific teeth and tooth types in both
primary and permanent teeth.
European Union has not been in a position to estimate the
impact and burden of periodontal diseases and its determinants and risk factors
on the morbidity rates and quality of life of the population. The prevalence of
moderate to severe attachment loss in the general population remains unclear in
many countries. The major reason is that the description of periodontal condition is
difficult, due to the scarcity of data from national studies based on a
representative sample of the population of the country. In addition, the
variation in methodological aspects of epidemiological studies markedly limits
comparisons between countries and regions. There is therefore a need to
address this deficiency. Surveillance of periodontal diseases condition should
encourage dental professionals, consumers, private and public health care
financing agencies, and decision-makers authorities to adopt an evidence-based
approach to periodontal services, in order to rationally control costs, help
assure quality and favourable outcomes, and extend more affordable dental care to
a wider public.
The WHO data bank is based on specific methods that are
recommended in oral health epidemiology, themselves resulting from basic
epidemiological methods. It seems that synthesis international articles i.e.
Pubmed databases are the main sources used to proceed to a state analysis of
trends. A critical analysis of the methodological criteria used published for
the oral health period 1986-1996 underlined weaknesses in the evaluation of
oral health trends: weaknesses in terms of methodology, quality control, and
presentation of results. The interpretation and conclusions in public oral
health are therefore limited. New and complementary trends should be
recommended so as to improve the production of higher quality information in oral health epidemiology.
The expansion of oral epidemiology during the 1970s
overcame the obvious shortcomings in terms of knowledge about the oral health
status of populations even though developed actions mainly targeted school
children. Collected data favoured cross-section studies with no repetitive
character since their aim was not to target the
cohorts. At this stage of the produced information analysis, research
and development perspectives should focus on the setting up of a health
monitoring and recording system and furthermore, on respecting the rules of
results dissemination that should lie within a benchmark methodological