The Oral Health of Older Adults in East London

Transcription

The Oral Health of Older Adults in East
London and the City in 2011
A Survey of Adults aged 65 years and older living in City and Hackney,
Newham and Tower Hamlets commissioned by NHS East London & the
City and conducted by the Institute of Dentistry, Barts and The London
School of Medicine and Dentistry, Queen Mary University of London
Wagner Marcenes
Vanessa Muirhead
Desmond Wright
Patricia Evans
Eunan O’Neill
Farida Fortune
Table of Contents
Acknowledgements
1. Executive Summary
2. Introduction
3. Aims
4. Methods
5. Results
5.1: Sample Description
5.1.1: Response Rate
5.1.2: Sample Representativeness
5.1.3: Non-Response Bias for the Clinical Examination
5.2: Reliability of Clinical Measurements
5.3: Oral Health and Function
5.3.1: Total Tooth Retention
5.3.2: Number and Condition of Natural Teeth
5.3.3: Denture Use
5.4: Disease and Related Disorders
5.4.1: Dental Caries Experience
5.4.2: Root Surface Conditions
5.4.3: Periodontal Conditions
5.4.4: Tooth Wear
5.5: Urgent Conditions
5.5.1: PUFA symptoms
5.5.2: Current Pain
5.6: Patient-Reported Oral Health Impacts and Perceived
Treatment Need
5.6.1: Oral Health -Related Quality of Life
5.6.2: Perceived Need for Treatment
5.7: Oral Health Behaviours
5.7.1: Toothbrushing and Denture Cleaning
5.7.2: Sugar Consumption
5.7.3: Smoking and Betel Quid/Paan Use
5.8: Use of Dental Services
5.8.1: Dental Attendance Patterns
5.8.2: Relationship with Dental Practice
5.8.3: Access to Dental Care Barriers
6. References
Appendix 1: Ethics Approval Letter
Appendix 2: Invitation Letter, Opt-in Card and Participant Information
Letter
Appendix 3: Older Adult Oral Health Survey Examination Criteria
Appendix 4: Older Adults Oral Health Survey: Examination Chart
Appendix 5: Medical Screening Check
Appendix 6: Referrals
Appendix 7: Feedback Forms
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Figures
Figure 1: Percentage of older adults living in East London and the City
(ELC) in 2011 and older adults living in England in 2009 with one or
more natural teeth (dentate) by age group
Figure 2: Mean number of natural teeth in older adults living in East
London and the City (ELC) in 2011 and older adults living in England in
2009 by age group
Figure 3: Mean number of natural teeth in the sample of older adults
living in East London and the City (ELC) in 2011 by ethnic group
(ELC) in 2011 and older adults living in the UK in 2009 with 21 or more
natural teeth by age group
Figure 5: Mean number of unfilled spaces in the front of the mouth in
the sample of older adults living in East London and the City (ELC) in
2011 by ethnic group
Figure 6: Mean number of sound teeth in older adults living in East
London and the City (ELC) in 2011 and older adults living in the UK in
2009 by age group
(ELC) in 2011 and older adults living in the UK in 2009 who wore
dentures by age group
Figure 8: Percentage of older adults who had one or more untreated
decayed tooth in older adults living in East London and the City (ELC) in
2011 and older adults living in the UK in 2009 by age group
Figure 9: Percentage of adults with one or more untreated decayed
tooth in the sample of older adults living in East London and the City
(ELC) in 2011 by age group
Figure 10: Mean number of filled teeth in older adults living in East
London and the City (ELC) in 2011 and older adults living in the UK in
2009 by age group
Figure 11: Mean number of filled teeth in the sample of older adults
living in East London and the City (ELC) in 2011 by ethnic group
Figure 12: Percentage of adults with one or more teeth with a exposed
root surface in older adults living in East London and the City (ELC) in
2011 and older adults living in the UK in 2009 by age group
Figure 13: Mean number of teeth with exposed root surfaces in the
sample of older adults living in East London and the City (ELC) in 2011
by age group
Figure 14: Percentage of adults with one or more teeth with an
untreated decayed root surface in older adults living in East London and
the City (ELC) in 2011 and older adults living in the UK in 2009 by age
group
Figure 15: Percentage of adults with bleeding, pocketing and loss of
attachment of 4mm and 6mm in the sample of older adults living in East
London and the City (ELC) in 2011 by ELC borough
Figure 16: Percentage of adults with bleeding, pocketing and loss of
attachment of 4mm and 6mm in the sample of older adults living in East
London and the City (ELC) in 2011 by ethnic group
Figure 17: Percentage of adults with one or more PUFA symptom in
older adults living in East London and the City (ELC) in 2011 and older
adults living in the UK in 2009 by age group
Figure 18: Percentage of adults reporting current oral pain in older
adults living in East London and the City (ELC) in 2011 and older adults
living in the UK in 2009 by age group
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Figure 19: Percentage of adults reporting at least one oral health impact
in the previous 12 months in older adults living in East London and the
City (ELC) in 2011 and older adults living in the UK in 2009 by age
group
Figure 20: Mean Oral Health Impact Profile-14 (OHIP-14) scores for the
by ethnic group
Figure 21: Mean Oral Health Impact Profile-14 (OHIP-14) scores for the
by borough
Figure 22: Percentage of adults who reported a perceived unmet
treatment need in a sample of older adults living in East London and the
City (ELC) in 2011 by ethnic group
Figure 23: Percentage of adults who were current smokers in the
by ethnic group
Figure 24: Percentage of adults reporting their last dental visit more
than two years ago in older adults living in East London and the City
(ELC) in 2011 and older adults living in the UK in 2009 by age group
Figure 25: Percentage of adults who reported reasons for not visiting
the dentist among those who had last visited the dentist more than two
years ago in a sample of older adults living in East London and the City
(ELC) in 2011
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Tables
Table 5.1.1.1: Household response rates for the sample of older adults
living in East London and the City (ELC) boroughs in 2011
Table 5.1.2.1: Frequency distribution by Index of Multiple Deprivation
(IMD) 2007 quintles in England in the sample of older adults living in
East London and the City (ELC) in 2011
Table 5.1.2.2: Frequency distribution by age, gender, and ethnicity in the
Table 5.1.2.3: Frequency distribution by borough in the population in
the census 2001 and in the sample of older adults living in East London
and the City (ELC) in 2011
Table 5.1.3.1: Number (%) of older adults who completed the survey
components by age, gender, ethnic group and East London and the City
(ELC) borough in the sample of older adult living in ELC in 2011
Table 5.2.1.2: Kappa Statistics assessing the reliability of clinical
examinations conducted in the sample of older adults living in East
London and the City (ELC) in 2011
Table 5.3.1.1: Percentage of adults who had one or more natural teeth
(dentate) by age, gender, ethnicity and East London and the City (ELC)
borough in the sample of older adults living in ELC in 2011
Table 5.3.2.1: Mean number of teeth by age, gender, ethnicity and East
London and the City (ELC) borough in the sample of older adults living
in ELC in 2011
Table 5.3.2.2: Percentage of adults with 21 or more teeth by age, gender,
ethnicity and East London and the City (ELC) borough in the sample of
older adults living in ELC in 2011
Table 5.3.2.3: Mean number of posterior functional contacts by age,
gender, ethnicity and East London and the City (ELC) borough in the
sample of older adults living in ELC in 2011
Table 5.3.2.4: Percentage of adults with one or more posterior
functional contacts by age, gender, ethnicity and East London and the
City (ELC) borough in the sample of older adults living in ELC in 2011
Table 5.3.2.5: Mean number of spaces in the front of the mouth (anterior
and premolar teeth) by age, gender, ethnicity and East London and the
Table 5.3.2.6: Percentage of adults with spaces in the front of the mouth
(anterior and premolar teeth) by age, gender, ethnicity and East London
and the City (ELC) borough in the sample of older adults living in ELC in
2011
Table 5.3.2.7: Mean number of sound and untreated teeth by age,
Table 5.3.2.8: Percentage of adults with 18 or more sound and untreated
teeth by age, gender, ethnicity and East London and the City (ELC)
Table 5.3.3.1: Number of adults with dentures by age, gender, ethnicity
and East London and the City (ELC) borough in the sample of older
adults living in ELC in 2011
Table 5.3.3.2: Number (%) of denture types in the sample of older adults
living in East London and the City (ELC) in 2011
Table 5.3.3.3. Number (%) of dentures by denture material in the
Table 5.3.3.4. Number (%) of dentures requiring repair in the sample of
older adults living in East London and the City (ELC) in 2011
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Table 5.4.1.1: Mean number of untreated decayed teeth into dentine by
age, gender, ethnicity and East London and the City (ELC) borough in
the sample of older adults living in ELC in 2011
Table 5.4.1.2: Percentage of adults with one or more untreated decayed
tooth into dentine age, gender, ethnicity and East London and the City
(ELC) borough in the sample of older adults living in ELC in 2011
Table 5.4.1.3: Mean number of missing teeth by age, gender, ethnicity
Table 5.4.1.4: Percentage of adults with one or more missing tooth by
Table 5.4.1.5: Mean number of filled teeth by age, gender, ethnicity and
East London and the City (ELC) borough in the sample of older adults
living in ELC in 2011
Table 5.4.1.6: Percentage of adults with filled teeth by age, gender,
Table 5.4.1.7: Mean number of teeth with caries experience (DMFT) by
Table 5.4.1.8: Percentage of adults with caries experience (DMFT>0) by
Table 5.4.2.1: Percentage of adults with exposed, worn, filled, and
decayed root surfaces in the sample of older adults living in ELC in 2011
Table 5.4.2.2: Mean number of teeth with exposed root surfaces by age,
Table 5.4.2.3: Percentage of adults with teeth with exposed root surfaces
by age, gender, ethnicity and East London and the City (ELC) borough in
Table 5.4.2.4: Mean number of teeth with untreated decayed root
surfaces by age, gender, ethnicity and East London and the City (ELC)
Table 5.4.2.5: Percentage of adults with untreated decayed root surfaces
Table 5.4.3.1: Percentage of adults who had teeth in one or more
sextants with bleeding by age, gender, ethnicity and East London and
the City (ELC) borough in the sample of older adults living in ELC in
2011
sextants with pocketing 4mm or more by age, gender, ethnicity and East
in ELC in 2011
sextants with loss of attachment 4mm or by age, gender, ethnicity and
East London and the City (ELC) borough in the sample of older adults
sextants with pocketing 6mm or more by age, gender, ethnicity and East
in ELC in 2011
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sextants with loss of attachment 6mm or more by age, gender, ethnicity
Table 5.4.3.6: Percentage of adults with visible plaque on one or more
teeth by age, gender, ethnicity and East London and the City (ELC)
sextants with calculus by age, gender, ethnicity and East London and the
Table 5.4.4.1: Mean number of sites with enamel wear, enamel/dentine
wear and wear involving the dentine/pulp complex by age, gender,
Table 5.4.4.2: Number (%) of adults with tooth wear based on the worst
score recorded at the 24 sites in the sample of older adults living in East
Table 5.4.4.3: Percentage of adults who had enamel/dentine wear and
wear involving the dentine/pulp complex as their worst recorded score
on the 24 sites by age, gender, ethnicity and East London and the City
Table 5.5.1.1: Number (%) of adults with individual PUFA symptoms in
the sample of older adults living in East London and the City (ELC) in
2011
Table 5.5.1.2: Percentage of adults with any PUFA symptom by age,
Table 5.5.2.1: Percentage of adults reporting current pain by age,
Table 5.6.1.1: Number (%)of adults who reported problems related to
oral conditions in the preceding 12 months in the sample of older adults
Table 5.6.1.2: Mean impact on quality of life (OHIP) score by age, gender,
Table 5.6.1.3: Percentage of adults who reported at least one impact
(OHIP-14) in the past 12 months by age, gender, ethnicity and East
in ELC in 2011
Table 5.6.2.1: Percentage of adults who perceived a need for treatment
in the sample of older adults living in East London and the City in 2011
Table 5.6.2.2: Percentage of adults who perceived a definitive need* for
treatment by age, gender, ethnicity and East London and the City (ELC)
Table 5.6.2.3: Percentage of adults who perceived a need for a denture
Table 5.7.1.1: Number (%) of adults who reported tooth cleaning
frequency in the sample of older adults living in East London and the
City (ELC) in 2011
Table 5.7.1.2: Number (%) of adults who reported denture cleaning
frequency in the sample of older adults living in East London and the
City (ELC) in 2011
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Table 5.7.1.3: Percentage of adults who cleaned their teeth less than
twice a day by age, gender, ethnicity and East London and the City (ELC)
Table 5.7.1.4: Percentage of adults who cleaned their dentures less than
twice a day by age, gender, ethnicity and East London and the City (ELC)
Table 5.7.2.1: Number (%) of adults who reported daily sugary intakes
in the sample of older adults living in East London and the City (ELC) in
2011
Table 5.7.3.1: Percentage of adults who were current smokers by age,
Table 5.7.3.2: Percentage of adults who chewed paan or betel nut in the
Table 5.8.1.1: Number (%) of adults reporting time since their last
dental visit in the sample of older adults living in East London and the
City (ELC) in 2011
Table 5.8.1.2: Percentage of adults whose last dental visit was more than
two years ago by age, gender, ethnicity and East London and the City
Table 5.8.1.3: Percentage of adults reporting usual reason for a dental
visit in the sample of older adults living in East London and the City
(ELC) in 2011
Table 5.8.1.4: Percentage of adults generally visit the dentist in response
to a dental problem by age, gender, ethnicity and East London and the
Table 5.8.1.5: Number (%) of adults reporting methods of dental
payments in the sample of older adults living in East London and the
City (ELC) in 2011
Table 5.8.2.1: Number (%) of adults who previously attended a dental
practice and who would visit the same practice for their next visit in the
Table 5.8.2.2: Number (%) of adults reporting patient-dentist
relationship characteristics in the sample of older adults living in East
Table 5.8.2.3: Number (%) of adults who received advice from their
dentist in the sample of older adults living in East London and the City
(ELC) in 2011
Table 5.8.3.1: Number (%) of adults reporting the reason for not visiting
the dentist in the past two years among older adults who had not visited
in the past two years in the sample of older adults living in East London
and the City (ELC) in 2011
Table 5.8.3.2: Number (%) of adults who tried to make an NHS dental
appointment in the last three years in the sample of older adults living
in East London and the City (ELC) in 2011
Table 5.8.3.3: Number (%) of adults who tried to make an NHS dental
appointment in the last three years and who were successful and
unsuccessful in the sample of older adults living in East London and the
City (ELC) in 2011
Table 5.8.3.4: Percentage of adults who tried to make an NHS dental
appointment in the last three years by age, gender and ethnicity in the
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Table 5.8.3.5: Number (%) of adults who reported the reason for making
the NHS dental appointment among those who attempted to in the
Table 5.8.3.6: Number (%) of adults who delayed dental treatment
because of cost in the sample of older adults living in East London and
the City (ELC) in 2011
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We appreciate the individuals who helped to organise and execute this survey.
We specifically thank:

Dr Harveen Kaur Ubhi, who excelled as Project Manager in this project

Dr Nicola Pearson, Dr Mary Henderson (Clinical Directors of the CDS) for their
support and advice

Dr Jeeti Chandhok (Senior Dental Officer in Newham), Dr Debra Simons
(Assistant Clinical Director in City and Hackney/Tower Hamlets), Dr Lisa Hirst
(Dental Officer in Newham), Dr Caroline Comyn (Dental Officer in Newham), Dr
Denise Williams (Dental Officer in City and Hackney/Tower Hamlets), Dr Jason
Trifourkis (Dental Officer in City and Hackney/Tower Hamlets) and Dr Dulguun
Ambaga (Dental Officers in City and Hackney/Tower Hamlets) for their
invaluable support, commitment, insightful contributions to the design of the
fieldwork as members of the steering group and for diligently carrying out the
dental examinations for this project

Frankie Bowman and Michelle Nansubuga, dental nurses in City and
Hackney/Tower Hamlets who worked as recorders in this project

Manny Eke, Rafia Munni and Tim Hole, members of the Tower Hamlets Oral
Health Promotion team
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Introduction
The UK population is undoubtedly ageing. Population estimates have shown that 1.7
million more adults aged 65 years and over lived in the UK in 2010 compared to
population estimates in 1985 (1). The life expectancy of UK adults reached its highest
recorded level in 2011 with a average life expectancy of 78.1 years for males and 82.1
years for females (1). In City and Hackney, Tower Hamlets and Newham, the life
expectancy for males ranged from 74.9 years to 75.3 years and for females, ranged from
79.8 years to 82.1 years in 2008 (2-4). Population projections also predict that 23% of
the UK population will be aged 65 and over by 2035 (1). Age projections for the East
London population estimate that approximately seven percent of adults will be aged 65
years and over by 2031 (2-4).
Even though national surveys suggests that older people live longer, retain more teeth
and have more complex dental needs than younger adults (5, 6), the scarcity of
information means that we do not know whether these trends exist locally, particularly
in East London and the City (ELC). Research has also confirmed the inextricable link
between poor oral health and deprivation in older adults (5). East London and the City is
characterised by high levels of social and material deprivation including high
unemployment rates, low levels of education, poor housing and high pensioner poverty
rates (2-5, 7).
To address this important knowledge gap, NHS East London and the City commissioned
the Institute of Dentistry; Barts and The London School of Medicine and Dentistry,
Queen Mary University of London (QMUL) to conduct an oral health survey of adults
aged 65 years and over living in four ELC boroughs: City of London, Hackney, Newham
and Tower Hamlets in 2011. This report summarizes the findings from the clinical
examination and survey questionnaire that assessed oral health and function, diseases
and related disorders, urgent conditions, the impact of dental conditions on people’s
quality of life, perceived need for treatment, oral health behaviours (i.e., tooth brushing
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and denture cleaning, sugar consumption and smoking and paan use); and the use of
dental services.
The report serves also as a guide for boroughs, the future NHS Commissioning Board,
Clinical Commissioning Groups and Local Authorities. It aims to specifically help
stakeholders to (i) commission and provide dental services using an outcome-based
commissioning approach (8); (ii) develop health promotion strategies targeting relevant
oral diseases that will reduce the need for treatment in older adults and (iii) identify
local barriers to accessing appropriate dental care services for older adults in ELC.
Survey Methodology
The survey used a cross-sectional stratified two-stage study design to recruit a
representative sample of adults aged 65 years and over living in private households in
City and Hackney, Newham and Tower Hamlets. Selected survey respondents completed
an interviewer-assisted questionnaire and underwent a clinical examination carried out
by trained and calibrated dentists in their own homes. The clinical examination used a
standardized protocol adapted from the 2009 UK Adult Dental Health Survey (9) to
assess oral diseases. The survey questionnaire assessed socio-demographic factors (i.e.,
age, gender, ethnicity); current oral pain and urgent conditions, the impact of dental
conditions on people’s quality of life, perceived need for treatment, oral health
behaviours (i.e., tooth brushing and denture cleaning, sugar consumption and smoking
and paan use); and the use of dental services.
The response rate for the survey in City and Hackney, Tower Hamlets and Newham was
55.9%, 53.8% and 52.6% respectively. This report analysed data from 772 adults who
completed the survey questionnaire and reported their age, gender and ethnic group
allowing survey weighting. Five hundred and twenty three (67.7%) older adults
completed both the survey questionnaire and clinical examinations. All analyses were
weighted to adjust for the unequal probability of selection and non-response and to
represent the population distribution related to age, gender and ethnicity reported in
the UK Census 2001. Data analyses also took into account the complex survey design
(stratification and clustering) to produce corrected standard errors and confidence
intervals.
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Total Tooth Retention
The vast majority (97.2%) of older adults living in East London and the City (ELC) had
one or more natural teeth (dentate). Less than three percent (2.8%) of older adults had
no natural teeth (edentulous). A higher percentage of older adults living in ELC aged 6574 years, 75- 84 years and 85 years and over were dentate compared to older adults
living in England and in the UK in 2009 (Figure 1). Older adults living in ELC had a mean
number of 26.6 natural teeth. Older adults living in ELC also had more natural teeth in
all older adults age ranges than older adults living in England and in the UK in 2009
(Figure 2).
Figure 1: Percentage of older adults living in East London and the City (ELC) in 2011 and older adults
living in England in 2009 with one or more natural teeth (dentate) by age group
100
75
% of older adults with
one or more natural
teeth (dentate)
50
25
0
65-74 years
75-84 years
85 years+
97.61
97.16
94.92
Older adults in England in 2009
85
71
55
Older adults in the UK in 2009
85
70
53
Older adults in ELC in 2011
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Figure 2: Mean number of natural teeth in older adults living in East London and the City (ELC) in 2011
and older adults living in England in 2009 by age group
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24
Mean number of
natural teeth
16
8
0
Older adults in England in 2009
65-74 years
75-84 years
85 years+
26.87
26.88
24.37
21
17.4
14.3
20.9
17.1
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Black older adults had the most natural teeth (Figure 3). Asian older adults had
significantly fewer natural teeth than Black and White older adults (Figure 3). Older
adults living in Newham (mean=22.7 teeth) also had fewer natural teeth than older
adults living in City and Hackney (mean=28.0 teeth).
Figure 3: Mean number of natural teeth in the sample of older adults living in East London and the City
(ELC) in 2011 by ethnic group
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24
Mean number of
natural teeth 16
8
0
Ethnic Group
White
Asian
Black
26.9
23.2
27.5
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Number and Condition of Natural Teeth
Eighty-one percent of older adults living in ELC had a functional dentition defined as
having of 21 or more teeth. Older adults living in ELC in 2011 were more likely to have a
functional dentition than older adults living in the UK in 2009 (Figure 4).
living in the UK in 2009 with 21 or more natural teeth by age group
100
75
21 or more teeth
50
25
0
65-74 years
75-84 years
85 years+
82.89
81.5
67.86
61
40
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Asian older adults (66.6%) living in ELC were less likely to have 21 or more teeth than
Black older adults (86.5%) and White older adults (82.1%). Older adults living in
Newham (68.2%) were also less likely to have a functional dentition than older adults
living in City and Hackney (85.2%).
Older adults living in ELC had a mean number of 2.19 posterior functional contacts.
Older adults aged 65-74 years (76.5%) and Black older adults (83.9%) were more likely
to have one or more posterior contact than older adults aged 75-84 years (66.3%),
adults aged 85 years and over (42.1%) and White older adults (68.0%).
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Eighty-two percent of older adults had one or more unfilled spaces in the front of their
mouths with an average of 6.5 unfilled spaces. Older adults aged 75-84 years (92.9%)
and older adults aged 85 years and over (89.8%) were more likely to have unfilled
spaces than adults aged 65-74 years (72.7%). White and Asian older adults also had
more unfilled spaces in the front of their mouths than Black older adults (Figure 5).
Figure 5: Mean number of unfilled spaces in the front of the mouth in the sample of older adults living in
East London and the City (ELC) in 2011 by ethnic group
8
6
Mean number of
unfilled spaces in the
front of the mouth
4
2
0
Ethnic Group
White
Asian
Black
6.7
6.8
5.3
Older adults living in ELC had on average 9.7 sound and untreated teeth; 13.4% of older
adults had 18 or more sound and untreated teeth. Older adults aged 65-74 years living
in ELC in 2011 had more sound teeth than older adults aged 65-74 years living in the UK
in 2009, while older adults aged 75 years and over living in ELC in 2011 had fewer
sound teeth than older adults aged 75 years and over living in the UK in 2009 (Figure 6).
Figure 6: Mean number of sound teeth in older adults living in East London and the City (ELC) in 2011 and
older adults living in the UK in 2009 by age group
15
10
Mean number of sound
teeth
5
0
65-74 years
75-84 years
85 years+
11.49
7.91
6.63
10.5
8.5
6.8
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Even though Asian older adults living in ELC had fewer natural teeth than White older
adults, Asian older adults (mean=11.3 sound teeth) and Black older adults (mean=16.5
sound teeth) had more sound and untreated teeth than White older adults (mean=8.9
teeth). Given that Asian older adults also had fewer filled teeth, this suggests that Asian
older adults were more likely to have had their teeth extracted rather than retained or
restored (See Dental Caries Experience, page xv).
Denture Use
Nearly half (47.4%) of older adults living in ELC wore dentures. A higher percentage of
older adults living in ELC in 2011 aged 65-74 years and 75-84 years wore dentures
compared to older adults in the same age ranges living in the UK in 2009 (Figure 7). In
contrast, a lower percentage of older adults aged 85 years and over living in ELC in 2011
wore dentures compared to the percentage of older adults aged 85 years and over living
in the UK in 2009 (Figure 7).
living in the UK in 2009 who wore dentures by age group
80
60
dentures
40
20
0
65-74 years
75-84 years
85 years+
38.57
55.86
63.01
29
45
70
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Older adults aged 75-84 years (55.8%) and female older adults (51.6%) living in ELC
were more likely to be denture wearers than older adults aged 65-74 years (38.6%) and
male older adults (42.0%). Fifty-five percent of the dentures identified during the
clinical examination were partial dentures, 30% were complete dentures, 10.6% were
paired partial and complete dentures and 4.2% were paired upper and lower complete
dentures. Most (85.7%) dentures were acrylic dentures and 19.3% of dentures were in
need of repair.
Untreated Decayed Teeth
Older adults living in ELC had relatively few untreated decayed teeth with a mean
number of 0.52 untreated decayed teeth. A quarter (24.9%) of older adults had one or
more untreated decayed tooth. Fewer older adults aged 65-74 years and 75-84 years
living in ELC in 2011 had one or more untreated decayed tooth than older adults aged
65-74 years and 75-84 years living in the UK in 2009 (Figure 8). In contrast, a higher
percentage of older adults aged 85 years and over living in ELC in 2011 had untreated
decayed teeth than older adults aged 85 years and over living in the UK in 2009 (Figure
8).
Figure 8: Percentage of older adults who had one or more untreated decayed tooth in older adults living in
East London and the City (ELC) in 2011 and older adults living in the UK in 2009 by age group
40
one or more untreated
decayed teeth
30
20
10
0
65-74 years
75-84 years
85 years+
18.87
31.43
34.39
22
35
28
Female older adults living in ELC (mean=0.4 decayed teeth) had fewer untreated
decayed teeth than male older adults (mean=0.7 decayed teeth). Older adults aged 75-84
years were more likely to have untreated decayed teeth than older adults aged 65-74
xviii
years (Figure 9). There were no significant ethnic group or borough differences related
to untreated decayed teeth.
Figure 9: Percentage of adults with one or more untreated decayed tooth in the sample of older adults
living in East London and the City (ELC) in 2011 by age group
40
30
% with one or more
untreated decayed
teeth
20
10
0
Age Group
65-74 years
74-84 years
85 years and over
18.9
31.4
34.4
Filled Teeth
Most (84%) older adults living in ELC had filled teeth. Older adults had a mean number
of 5.2 filled teeth. Older adults living in ELC in 2011 had fewer filled teeth than older
adults living in the UK in 2009 (Figure 10).
Figure 10: Mean number of filled teeth in older adults living in East London and the City (ELC) in 2011 and
older adults living in the UK in 2009 by age group
10
8
Mean number of filled
teeth
6
4
2
0
65-74 years
75-84 years
85 years+
5.75
4.94
3.29
8.3
6.9
6
xix
Asian and Black older adults living in ELC had significantly fewer filled teeth than White
older adults (Figure 11). Older adults living in Newham had fewer filled teeth (mean=4.0
filled teeth) than older adults living in City and Hackney (mean=5.8 filled teeth).
Figure 11: Mean number of filled teeth in the sample of older adults living in East London and the City
(ELC) in 2011 by ethnic group
8
6
Mean number of
filled teeth
4
2
0
Ethnic Group
White
Asian
Black
5.8
2.1
3.2
Root Surface Conditions
Most (93%) older adults living in ELC had teeth with exposed root surfaces, 20.4% had
teeth with worn root surfaces, 38.1% had teeth with filled root surfaces and 18.0% of
older adults had teeth with untreated decayed root surfaces. Older adults living in ELC
had a mean number of 13.4 root-exposed teeth representing approximately half of older
adults’ remaining teeth with signs of root exposure. The marginally lower percentage of
older adults living in ELC in 2011 in all age ranges had root exposure teeth compared to
older adults living in the UK in 2009. The difference was greatest among older adults
aged 85 years and over (Figure 12).
xx
Figure 12: Percentage of adults with one or more teeth with a exposed root surface in older adults living in
East London and the City (ELC) in 2011 and older adults living in the UK in 2009 by age group
100
one or more teeth with
exposed root surfaces
75
50
25
0
65-74 years
75-84 years
85 years+
93.68
93.86
85.49
96
98
97
Root exposure also increased with age and varied with ethnicity and borough. Older
adults aged 65-74 years (Figure 13) and Black older adults (mean=16.3 exposed teeth)
had the most root exposed teeth. Older adults living in City and Hackney (mean=14.2
root-exposed teeth) also had significantly more root exposed teeth than older adults
living in Newham (mean=11.7 root-exposed teeth).
Figure 13: Mean number of teeth with exposed root surfaces in the sample of older adults living in East
London and the City (ELC) in 2011 by age group
40
30
Number of teeth with
exposed root surfaces
20
10
0
Age Group
65-74 years
74-84 years
85 years and over
15.5
11.5
8.1
xxi
Older adults living in ELC had a mean number of 0.3 teeth with untreated decayed root
surfaces. Eighteen percent of older adults living in ELC had one or more teeth with an
untreated decayed root surface. While 17% of older adults aged 85 years and over living
in the UK in 2009 had teeth with untreated decayed root surfaces, 31.3% of older adults
aged 85 years and over living in ELC had teeth with untreated decayed root surfaces
(Figure 14).
Figure 14: Percentage of adults with one or more teeth with an untreated decayed root surface in older
adults living in East London and the City (ELC) in 2011 and older adults living in the UK in 2009 by age
group
50
one or more teeth with
an untreated decayed
root surface
40
30
20
10
0
65-74 years
75-84 years
85 years+
11.84
23.85
31.27
10
20
17
The mean number of teeth with untreated decayed root surfaces increased with age.
While 11.8% of older adults aged 65-74 years had one or more teeth with untreated
decayed root surfaces, nearly a third (31.3%) of older adults aged 85 years and over had
teeth with untreated decayed root surfaces.
Periodontal Diseases
The presence of bleeding on probing, periodontal pocketing and loss of attachment
assess the condition of the periodontal structures (e.g. gums and bone) that support and
maintain natural teeth. Forty-seven percent of older adults living in ELC showed signs of
bleeding on probing indicating gingivitis (gum inflammation). Fifty-eight percent of
older adults living in ELC had teeth in one or more sextants with pocketing of 4mm or
more and 67.3% of adults had teeth in one or more sextants with loss of attachment of
4mm or more. Eighteen percent of older adults had one or more sextant with pocketing
of 6mm or more and 25.3% of older adults had one or more sextant with loss of
xxii
attachment of 6mm or more indicative of more severe periodontal disease. The
percentage of older adults living in ELC in 2011 who had sextants with bleeding,
pocketing and loss of attachment of more than 4mm and more than 6mm were
comparable to older adults living in England and in the UK in 2009.
There were significant age, ethnic group and borough differences related to bleeding,
pocketing and loss of attachment among older adults living in ELC. Older adults aged 7584 years (34.8%) were more likely to have loss of attachment of 6mm or more than
older adults aged 65-74 years (18.7%). Older adults living in Newham were more likely
to show signs of bleeding than adults living in City and Hackney (Figure 15). However,
older adults living in Newham were less likely to have one or more sextants with loss of
attachment of 4mm or more than older adults living in Tower Hamlets and older adults
living in City and Hackney (Figure 15). Older adults living in Newham and older adult
living in Tower Hamlets were less also likely to have loss of attachment of 6mm or more
than older adults living in City and Hackney (Figure 15). Asian older adults were more
likely to have pocketing of 6mm or more than White older adults (Figure 16).
Figure 15: Percentage of adults with bleeding, pocketing and loss of attachment of 4mm and 6mm in the
sample of older adults living in East London and the City (ELC) in 2011 by ELC borough
80
60
%
40
20
0
City and Hackney
Tower Hamlets
Newham
% of older adults with bleeding
38.4
47.7
55
% of older adults with pocketing ≥ 4mm
63.3
55.3
59.3
% of older adults with loss of
attachment ≥ 4mm
73.7
70.2
55.9
17.2
16.4
20.9
attachment ≥ 6mm
37.7
24.8
15.3
xxiii
Figure 16: Percentage of adults with bleeding, pocketing and loss of attachment of 4mm and 6mm in the
sample of older adults living in East London and the City (ELC) in 2011 by ethnic group
80
60
%
40
20
0
White
Asian
Black
% of older adults with bleeding
41.15
49.87
48.35
56.03
68.63
68.48
attachment ≥ 4mm
66.16
74.06
70.19
15.8
30.97
22.51
attachment ≥ 6mm
24.59
30.13
27.18
Sixty-four percent of older adults living in ELC had visible plaque on one or more teeth
and 71.8% of older adults had calculus present on one or more teeth. There were no
significant differences between the percentage of older adults who had visible plaque
and calculus among older adults living in ELC in 2011 and older adults living in the UK in
2009. There were no significant age, gender, ethnic group or borough differences
related to visible plaque and detectable calculus among older adult living in ELC in 2011.
Tooth Wear
Dental examiners measured tooth wear in older adults at three thresholds: any wear,
moderate wear exposing a large area of dentine on any surface of the tooth and severe
wear exposing the pulp or secondary dentine, following the 2009 Adult Dental Health
Survey criteria (9). Examiners assessed wear on three surfaces on six upper anterior
(front) teeth: the outer surfaces (buccal), the inner surfaces (palatal) and the cutting
surfaces (incisal). Examiners also scored the worst affected surface on the six lower
anterior (front) teeth. Forty-nine percent of older adults had their worst recorded wear
involving loss of enamel just exposing dentine teeth, 34.5% had worst recorded wear
involving enamel/dentine exposing more than a third of the tooth surface and 11.82%
had their worst recorded score involving the dentine/pulp complex. Older adults aged
xxiv
85 years and over (66.6%) were more likely to have enamel/dentine wear and wear
involving the dentine/pulp complex than older adults aged 65-74 years (45.5%).
Urgent Conditions and Pain
The PUFA index is a newly developed index that assesses the consequences of advanced
tooth decay that require immediate attention (10). Four percent of older adults had one
or more caries-related ulceration, three percent of adults had an open pulp, 1.5% had a
fistula and 0.5% had an abscess. Eight percent of older adults living in ELC had one or
more PUFA symptoms. A higher percentage of older adults aged 75 years and over living
in ELC in 2011 had any PUFA symptoms than older adults aged 75 years and over living
in the UK in 2009 (Figure 17). There were no significant age, gender, ethnic group or
borough differences related to PUFA symptoms.
Figure 17: Percentage of adults with one or more PUFA symptom in older adults living in East London and
the City (ELC) in 2011 and older adults living in the UK in 2009 by age group
20
any PUFA symptoms
15
10
5
0
65-74 years
75-84 years
85 years+
5.93
10.33
15.88
6
8
10
Ten percent of older adults living in ELC were currently experiencing pain in their
mouths. A higher percentage of older adults living in ELC in 2011 experienced current
oral pain than older adults living in the UK in 2009 (Figure 18). Fewer older adults aged
65-74 years (9.0%) reported pain than older adults aged 85 years and over (31.2%).
There were no significant gender, ethnic group or borough differences related to adults
currently experiencing oral pain.
xxv
Figure 18: Percentage of adults reporting current oral pain in older adults living in East London and the
City (ELC) in 2011 and older adults living in the UK in 2009 by age group
40
% of older adults
currently experiencing
oral pain
30
20
10
0
65-74 years
75-84 years
85 years+
9.03
5.51
31.19
6
4
5
The Impact of Dental Conditions on Quality of Life
More than half (53%) of older adults living in ELC experienced at least one oral health
impact affecting their quality of life in the previous 12 months. Physical pain impacts
related to having a painful “aching” mouth (30.2%) and uncomfortable eating (29.6%)
were the most common impacts. Eighteen percent of older adults reported that dental
problems had caused them to interrupt meals (18.0%) while 13% had eaten an
unsatisfactory diet because of problems with their teeth or mouth. More older adults
living in ELC in 2011 reported at least one oral health impact in the previous 12 months
than older adults living in the UK in 2009 (Figure 19).
xxvi
Figure 19: Percentage of adults reporting at least one oral health impact in the previous 12 months in
older adults living in East London and the City (ELC) in 2011 and older adults living in the UK in 2009 by
age group
80
% of older adults
reporting at least one
oral health impact in
the past 12 months
60
40
20
0
Older adults in INEL in 2011
65-74 years
75-84 years
85 years+
53.47
48.2
66.69
36
34
42
Older adults aged 85 years and over (mean OHIP-14=10.5), Asian older adults (Figure
20) and older adults living in Tower Hamlets (Figure 21) reported significantly higher
OHIP scores (indicating more severe impacts) than adults aged 65-74 years (mean
OHIP-14=6.04), White older adults and adults living in City and Hackney (Figure 20 and
Figure 21).
Figure 20: Mean Oral Health Impact Profile-14 (OHIP-14) scores for the sample of older adults living in
East London and the City (ELC) in 2011 by ethnic group
10
8
Mean OHIP Score
6
4
2
0
Ethnic Group
White
Asian
Black
5.82
7.82
6.8
xxvii
Figure 21: Mean Oral Health Impact Profile-14 (OHIP-14) scores for the sample of older adults living in
East London and the City (ELC) in 2011 by borough
10
8
6
Mean OHIP Score
4
2
0
ELC Borough
City and
Hackney
Tower Hamlets
Newham
4.83
6.84
5.95
Perceived Need for Dental Treatment
Nearly half of the older adults in the survey (49.2%) expressed a definitive need for
dental treatment. Black older adults were more likely to report an unmet dental
treatment need than White older adults (Figure 22). While 32.7% of older adults living
in Newham felt that they had an immediate dental treatment need, 58.5% of older adults
living in City and Hackney reported a perceived need for dental treatment. Half (50.3%)
of all older adults in ELC felt that they required a denture. Older adults aged 75-84 years
(57.6%) and older adults aged 85 years and over (70%) were likely to perceive a need
for a denture than older adults aged 65-74 years (42%).
Figure 22: Percentage of adults who reported a perceived unmet treatment need in a sample of older
adults living in East London and the City (ELC) in 2011 by ethnic group
80
60
%
40
20
0
Ethnic Group
White
Asian
Black
48.3
45.7
60.6
xxviii
Oral Health Behaviours: Toothbrushing and denture cleaning
Sixty-five percent of older adults in ELC cleaned their teeth twice a day or more often,
similar to older adults living in the England in 2009 (68%). Toothbrushing habits varied
by age, gender, ethnic group and ELC borough. Older adults aged 85 years and over
(59.2%) and men (45.2%) were more likely to report tooth brushing less than twice a
day than older adults aged 65-74 years (30.3%) and women (26%). More than a third
(38.7%) of White older adults cleaned their teeth less than twice day compared to only
18.4% of Asian and 18.4% of Black older adults. Older adults living in City and Hackney
(37.2%) were more likely to brush less often than older adults living in Newham
(20.9%). Fifty-six percent of adults who had dentures cleaned their dentures less than
twice a day. Similarly, White older adults (59.4%) were more likely to clean their
dentures less than twice a day than Asian older adults (47.5%) and Black older adults
(36.9%).
Oral Health Behaviours: Sugar Consumption
Older adults in ELC answered questions about their daily sugar intake of eight different
food and drink items: chocolate, sweet biscuits or cookies, cakes, ice creams or lollies,
sweet yogurt, confectionary or other sweets, sweetened fruit juice and fizzy drinks. Less
than three percent (2.5%) of older adults consumed more than four sugary intakes a
day, exceeding the World Health Organization’s daily sugar intake recommendation
(11).
Oral Health Behaviours: Current Smoking and Paan Use
Twelve percent of older adults in ELC were current smokers. A higher percentage of
older adults living in ELC in 2011 aged 65-84 years were current smokers compared to
the percentage of older adult smokers aged 65-84 years living in England in 2009.
However, four percent of older adults living in ELC aged 85 years and over were
smokers compared to six percent of older adults aged 85 years and over living in
England in 2009.
Asian older adults reported the highest prevalence of current smoking (Figure 23).
White older adults were more likely to be current smokers than Black older adults
(Figure 23). Four percent of older adults currently chewed paan or betel quid. Sixty-one
xxix
percent of older adult paan-chewers were Asian, 30% were White and nine percent
were Black older adults.
Figure 23: Percentage of adults who were current smokers in the sample of older adults living in East
London and the City (ELC) in 2011 by ethnic group
20
15
%
10
5
0
White
Asian
Black
11.9
17.4
4.79
Ethnic Group
Use of Dental Services: Dental Attendance Patterns
Sixty-eight percent of older adults made their last visit to the dentist within the past two
years, adhering to the recommended dental recall National Institute for Health and
Clinical Excellence (NICE) guidelines (12) while 32% of older adult living in ELC had
their last dental visit more than two years ago. A higher percentage of older adults living
in ELC in 2011 had their last dental visit more than two years ago than older adults
living in the UK in 2009 (Figure 24).
Figure 24: Percentage of adults reporting their last dental visit more than two years ago in older adults
living in East London and the City (ELC) in 2011 and older adults living in the UK in 2009 by age group
60
% of older adults
whose last dental visit
was more than two
years ago
40
20
0
65-74 years
75-84 years
85 years+
25.56
36.28
47.43
13
15
19
xxx
There were no significant gender or borough differences related to the time since their
last dental visit but there were age and ethnic group differences. Older adults aged 7584 years (Figure 24), older adults aged 85 years and over (Figure 24), Asian older adults
(38.7%) and Blacks older adults (36.7%) were more likely to have last visited the
dentist more than two years than older adults aged 65-74 years (Figure 24) and White
older adults (30.3%).
Forty-six percent of older adults in ELC usually visited a dentist in response to a dental
problem rather than for regular or occasionally check-ups. More Asian (67.8%) and
Black older adults (58.6%) usually visited the dentist in response to a dental problem
than White older adults (43.9%).
Most (82%) older adults received NHS dental care services with 40.5% of adults
receiving free NHS care. Only 12.9% of older adults received exclusively private dental
care.
Use of Dental Services: Relationship with the Dental Practice
The vast majority (81.7%) of older adults visited a previously attended dental practice
at their last dental visit and intended to visit the same practice for their next visit. Most
older adults reported good patient-dentist relationships. Ninety–four percent felt that
the dentist had treated them with respect and dignity; most adults (89.1%) expressed
confidence and trust in their dentist. Almost two-thirds (63%) of older adults felt that
their dentist had given them adequate time to discuss their oral health and more than
half (57.8%) felt that they had been involved in their dental care making decisions.
However, fewer older adults had received recommended preventive oral health advice
from their dentist. Fifty-one percent of older adults recalled advice given by their dentist
about dental visits. Less than half (46.8%) had received advice from their dentist about
toothbrushing; 23.5% had received smoking cessation advice and only 16.6% had
received dietary advice. Fifty-three percent of smokers had received smoking cessation
advice
xxxi
Use of Dental Services: Access to Care Barriers
Sixty-two percent of older adults tried to make a NHS appointment in the past three
years. The majority (94.8%) of older adults who tried to make an appointment
successfully saw a dentist. Older adults aged 85 years and over (45.7%) were less likely
to have attempted to make a NHS appointment in the previous three years than adults
aged 65-74 years (68.3%). Thirty-seven percent of older adults made a NHS
appointment for a routine check-up, 33.6% made an appointment for non-urgent
treatment and a quarter (25.3%) of older adults made an emergency treatment
appointment.
The most common response for not visiting the dentist within the past two year was “no
need” or the belief that there were no tooth problems warranting a dental visit (42%)
(Figure 25). Fifteen percent of adults who had not attended gave other reasons including
poor health or health conditions, lack of need because of long-term complete tooth loss,
the lack of contact with a new dentist or other priorities. Thirteen percent of older
adults had not attended because of fear and six percent of older adults had not attended
because of a prior bad experience. Twelve percent of older adults had difficulty
travelling to or from the dental practice, which prevented them from attending. Three
percent of older adults reported not visiting the dentist because they were unable to
afford NHS dental charges and 1.2% could not find a dentist (Figure 25). Seventeen
percent of older adults had delayed dental treatment because of the cost.
Figure 25: Percentage of adults who reported reasons for not visiting the dentist among those who had
last visited the dentist more than two years ago in a sample of older adults living in East London and the
City (ELC) in 2011
60
42.1
40
6.6
3.2
2.6
2.4
1.6
1.2
Can't Afford NHS
charges
No time
Keep Forgetting
Dentist changed
to private
Can't find a NHS
dentist
14.6
8.1
Bad experience
12.3
Not Answered
13.5
20
Other reason
Difficult to get to
and from the
dentist
Afraid of dentists
0
No need
%
xxxii
Key findings: Oral Health and Health Behaviours of Older Adults Living in East
Dental Status
 The vast majority (97.2%) older adults living in ELC in 2011 were dentate, exceeding the percentage of
dentate older adults living in England and in the UK in 2009. Older adults living in ELC had a mean
number of 26.6 natural teeth. Eighty-one percent of older adults living in ELC had a functional dentition
with 21 or more natural teeth. Older adults living in ELC were more likely to have a functional dentition
than older adults living in the UK in 2009.
Dental Decay Experience
 Older adults living in ELC in 2011 had also better oral health related to decay experience than older
adults living in the UK in 2009. Almost a quarter (24.9%) of older adults living in ELC in 2011 had
untreated decayed teeth with a mean of 0.52 untreated decayed teeth. Fewer older adults living in ELC
aged 65-84 years had untreated decayed teeth compared to older adults aged 65-84 years living in the
UK in 2009. Older adults living in ELC also had fewer filled teeth than older adults living in the UK in
2009.
Periodontal Disease
 Fifty-eight percent of older adults living in ELC in 2011 had sextants with pocketing of 4mm or more
and 67.3% had sextants with loss of attachment of 4mm or more indicative of moderate periodontal
disease. Eighteen percent of older adults had sextants with pocketing of 6mm or more and 25.3% of
older adults sextants with loss of attachment of 6mm or more indicative of more severe periodontal
disease. The prevalence of periodontal disease in older adults living in ELC in 2011 was comparable to
the prevalence of periodontal disease in older adults living in England in 2009.
Oral Pain
 Ten percent of older adults living in ELC in 2011 experienced oral pain. Older adults living in ELC were
more likely to report current oral pain than older adults living in the UK in 2009. Older adults aged 85
years and over living in ELC experienced the most oral pain and exhibited the largest difference
compared to UK averages. Thirty-one percent of older adults living in ELC in 2011 experienced oral
pain compared to only five percent of older adults aged 85 years and over living in the UK in 2009.
Oral Health-Related Quality of Life
 More than half (53%) of older adults living in ELC in 2011 experienced an oral health impact in the
previous 12 months. Older adults living in ELC were more likely to report an oral health impact in the
previous 12 month than older adults living in the UK in 2009.
Oral Health Behaviours
 Sixty-five percent of older adults living in ELC cleaned their teeth twice a day or more often, similar to
older adults living in the UK in 2009. Twelve percent of older adults in ELC were current smokers with
a higher percentage of older adults aged 65-84 years being smokers than older adults aged 65-84 years
the UK in the 2009. Less than three percent (2.5%) of older adults living in ELC ate four sugary intakes a
day, exceeding the World Health Organization’s daily sugar intake recommendation (11).
Use of Services
 Sixty-eight percent of older adults adhered to the recommended dental recall guidelines and visited the
dentist within the past two years. However, more older adults living in ELC in 2011 had their last dental
visit more than two years ago compared to older adults living in the UK in 2009.
xxxiii
The UK population is undoubtedly ageing. Population estimates have shown that 1.7
million more adults aged 65 years and over lived in the UK in 2010 compared to
population estimates in 1985 (1). The life expectancy of UK adults reached its highest
recorded level in 2011 with an average life expectancy of 78.1 years for males and 82.1
years for females (1). In East London, the life expectancy for males ranged from 74.9
years to 75.3 years and for females, ranged from 79.8 years to 82.1 years in 2008 (2-4).
Population projections also predict that 23% of the UK population will be aged 65 and
over by 2035 (1). Age projections for the East London population estimate that
approximately seven percent of adults will be aged 65 years and over by 2031 (2-4).
Massive improvements in general and oral health in the UK over the past five decades
have led to adults not only living longer but also retaining their natural teeth
throughout adulthood. Adult Dental Health Surveys have shown that while only 21% of
adults aged 65 years and over had at least one natural tooth (dentate) in 1978, 82% of
adults aged 65 years and over were dentate in 2009 (5, 13).
The fact that older people retain rather than lose their teeth places them at risk of oral
diseases such as tooth decay (dental caries), periodontal gum (diseases) and tooth wear.
Dental decay also occurs on the root surfaces of teeth exposed by receding gums, which
is more prevalent in older age groups (13). Older people often have more complex
dental treatment needs compounded by systemic diseases (i.e., diabetes), physical
disabilities caused by strokes and degenerative diseases and medications that cause dry
mouth. Chronic diseases prevalent among the aged compromise their immune systems
and may limit oral health behaviours such as oral hygiene, which increases the risk of
common oral diseases such as periodontal (gum) diseases. Oral diseases can
significantly impact older people’s quality of life by causing pain and discomfort, eating
and speaking difficulties and psychological and social impairment such as
embarrassment and social isolation related to poor aesthetics (14).
1
Joint Strategic Needs Assessments (JSNAs) have been an statutory requirement for
Primary Care Trusts since 2007, to identify the current and future health needs of local
populations (15). Even though oral health surveys are an essential part of JSNAs, no oral
health surveys have assessed the oral health needs and behaviours of older adults living
in East London and the City (ELC). Assessing the oral health of older adults in ELC is
particularly important given the inextricable link between oral diseases and
deprivation: low-income individuals have poorer oral health than their high –income
counterparts (16). Older ELC residents are economically vulnerable demonstrated by
the proportion of older people reliant on income-related benefits (17, 18). Data from the
Department for Work and Pensions (DWP) showed that Hackney, Newham and Tower
Hamlets were ranked 2nd, 5th and 7th most deprived borough in relation to pensioner
poverty (17). Moreover, the elderly often have difficulty accessing local health services
in London because of the lack of suitable transport, physical disabilities and
communication barriers (19).
NHS East London and the City commissioned the Institute of Dentistry; Barts and The
London School of Medicine and Dentistry; Queen Mary University of London to conduct
this oral health survey of adults aged 65 years and older living in City and Hackney,
Newham and Tower Hamlets in 2011 to address the information gap. The survey
followed the 2009 Adult Dental Health Survey methodology and diagnostic criteria.
We present the key findings from the survey in this report. This report summarizes the
findings from the clinical examination and survey questionnaire, which assessed oral
health and function, diseases and related disorders, urgent conditions, the impact of
dental conditions on people’s quality of life, perceived need for treatment, oral health
behaviours (i.e., tooth brushing and denture cleaning, sugar consumption and smoking
and paan use); and the use of dental services.
The report serves as a guide for borough, the future NHS Commissioning Board, Clinical
Commissioning Groups and Local Authorities. It aims to specifically help stakeholders to
(i) commission and provide dental services using an outcome-based commissioning
approach (8); (ii) develop health promotion strategies targeting relevant oral diseases
2
that will reduce need for treatment in older adults and (iii) identify local barriers to
accessing appropriate dental care services for older adults in ELC.
3

To assess and compare the oral health status of older adults living in City and
Hackney, Tower Hamlets and Newham boroughs in East London and the City
(ELC) in 2011

To compare the oral health of older adults living in ELC in 2011 by age, gender
and ethnic groups

To assess the impact of oral health on quality of life, urgent dental need
conditions and perceived need for dental treatment in older adults living in ELC
in 2011 by age groups, gender, ethnic groups and boroughs

To assess oral health behaviours :tobacco use, sugar consumption and tooth and
denture cleaning reported by older adults in ELC in 2011 by age groups, gender,
ethnic groups and boroughs

To investigate older adults’ experiences of using oral health services and barriers
to access in ELC in 2011
4
Study Design
A survey collects information to describe and/or compare the oral health status,
knowledge, attitudes and behaviours of individuals. It uses a systematic approach to
collect data from survey respondents about diseases and health conditions in a way that
allows comparisons between data collected in different settings. We used a stratified
cross-sectional survey design. Cross-sectional surveys assess the presence or absence of
diseases and other health-related information in groups of individuals at one point in
time. A stratified survey meant dividing the East London and the City (ELC) population
into wards (strata) and selecting a random sample from each stratum.
Ethical approval
The East London Research Ethics Committee approved the survey protocol and
supporting documentation in February 2011 (Appendix 1).
Sample Size Calculation
Our sample size estimation proposed to include 250-300 adults per borough based on
the minimal sample size recommended by the British Association for the Study of
Community Dentistry (BASCD) (20). This minimal sample size of 750-900 adults would
allow further breakdown of the sample into three boroughs.
Sample Recruitment
A stratified two-stage randomised survey design was used to obtain a representative
sample of adults aged 65 years and over in the four ELC boroughs. The sampling frame
comprised all addresses in ELC obtained from GP lists stratified by the 61 wards (strata)
in City and Hackney, Tower Hamlets and Newham. The sampling frame excluded
businesses, institutions and empty addresses. A maximum of two adults aged 65 years
and over living in each selected household were invited to undergo a clinical
examination and an interviewer-assisted survey questionnaire. Non- responding older
adults were replaced by older adults within the same postcode.
5
Contacting Potential Participants
The fieldwork was conducted in two phases with older adults first completing the
survey questionnaire followed by the clinical examination. Potential participants at
sampled addresses were sent an invitation letter, an information sheet, an opt-in card
and a prepaid return envelope (Appendix 2). The information sheet explained the
purpose of the survey and confirmed that the survey was voluntary. Potential
participants were asked to complete and return the opt-in card by post with their
telephone number, specified time availability, and their venue and gender preferences
related to the examining dentist and interviewer. Appointments were arranged for
participants who returned the opt-in cards in accordance with their specified
preferences. A research assistant visited households if we received no reply letter to
confirm whether non-responding households were vacant. If occupants did reside in the
non-responding households, the research assistant confirmed if the occupants had
received and read the invitation letter; if there were any language barriers and if any
occupants were aged 65 years and over. We offered translation for non-English
speakers and multilingual interviewers were available if needed.
Training and Calibration Exercise
The data collection team consisted of qualified dentists (dental examiners) who
conducted the clinical examination and interviewers who recorded the information
from the clinical examinations and administered the survey questionnaires. All
members of the data collection team participated in training sessions before starting
data collection covering the clinical procedures, protocols and criteria used. Dental
examiners and interviewers received the criteria and examination forms prior to the
first training session. They studied the criteria and memorised the codes specified for
each clinical condition. Interviewers received the questionnaire and took part in a
formal training exercise about how to administer the questionnaires to older adults. The
examiners were calibrated to ensure a high level of agreement and allow for reliable
comparability.
6
Infection Control
The clinical examinations were conducted in accordance with Tower Hamlets borough
Community Infection Control policy (21). Data collection teams carried a sufficient
number of sterile instruments to ensure that examiners used a separate set of
instruments for each participant.
Consent
All participants received participant information sheets (Appendix 2) and signed
separate consent forms for the survey questionnaire and the clinical examination.
Clinical Examination
The clinical examination assessed the hard and soft tissues inside the mouth. The intraoral examination specifically assessed coronal and root untreated decay, filled, and
missing teeth due to decay, number of anterior posterior functional contacts, type of
denture, status of denture, need for a denture and periodontal status, following the
2009 UK Adult Dental Health Survey diagnostic criteria (Appendix 3). Recorders used a
specially designed examination chart to record the clinical data (Appendix 4).
Equipment Set-Up and Seating Arrangements
Dental examiners used sterile disposable instruments to ensure optimal infection
control. A Daray lamp provided a standardised source of light for all examinations. The
lamp was conveniently positioned for participants taking into account available power
points. It was often clamped to an ironing board or to a table. The light was set up,
adjusted to an appropriate position and set at the highest power setting (II). All
participants wore dark protective glasses. The instruments were laid out on the tray out
of sight of the participant when possible, but allowing easy access for the dental
examiner.
Conducting the Clinical Examination
Recent National Institute for Health and Clinical Excellence (NICE) guidelines (22)
dictate that periodontal probing does not pose a significant risk for patients with a
previous history of Rheumatic Fever or other cardiac disorders. Hence, dental
7
examiners asked participants about their medical history before starting the clinical
examination and completed the medical screening check for their own records
(Appendix 5). Dental examiners were advised to explain the new recommendations if
participants expressed concerns about probing based on former guidelines, previously
recommending not probing high-risk patients (Appendix 3).
Dentists examined participants seated in a comfortable chair, easily accessible to the
dental examiner with good head support. Participants did not brush their teeth prior to
the examination, but sometimes rinsed their mouths. Debris and/or moisture was
removed gently from individual sites with gauze, cotton wool rolls or cotton wool buds
if visibility was obscured. Probes were used for cleaning debris from the tooth surfaces
to enable satisfactory visual examination. Dental examiners did not use compressed air
to ensure comparability and maintain infection control. The clinical examination did not
include radiographs or fibre-optic transillumination. The convention throughout all
clinical examinations was to score low (i.e., record the lowest level of disease) if in
doubt. Appendix 3 describes the examination procedure in detail.
Referral for Treatment for People Requiring Further Care
The data collection team had referral forms (Appendix 6) available for dentists to
complete and return to the project manager. The project manager ensured that an
appointment was made with an appropriate care provider for further assessment and
treatment.
The project manager liaised with the borough to identify a dentist available to provide
treatment if the dentist identified a participant needing treatment. The project manager
also organised referrals for further examination and treatment at the Institute of
Dentistry, Barts and The London School of Medicine and Dentistry for participants
identified with any suspicious lesions.
Dental examiners used appropriate wording to inform participants who had suspect
lesions. Dentists were advised to first introduce the subject by asking whether the
lesion caused any discomfort and then use a standardized response, “It is survey policy
that a brief report of any ulcers or inflamed areas is passed on to a consultant at the
8
Institute of Dentistry. The consultant will write to you offering an appointment for further
examination and diagnosis.” Dental examiners asked participants if they verbally agreed
to the referral and participants signed a standard form, which recorded their doctor’s
name and details (Appendix 5). Participants were encouraged to arrange to see their
doctor within two weeks if they specified that they would arrange their own
appointment with their doctor. They also signed a statement confirming that they
refused the referral in favour of making their own arrangements for further
examination and diagnosis. Examiners were advised to use the standardized response,
“It is not possible to know without a proper further assessment by a consultant,” if
participants asked dental examiners about what they thought the lesion was.
The project manager organised an appointment for participants with suspect lesions
with an oral medicine consultant at the Institute of Dentistry. Consultants contacted
participants’ doctors and the borough by letter sending a copy of the consent form and
the dentist’s record form.
Providing Clinical Feedback
Dental examiners were advised to respond to participants who sought further
information about specific aspects of past treatment by replying, “this survey is limited
and you need to see your (or a) dentist for specific advice on any treatment you had in the
past’.
The data collection team advised participants during recruitment that dental examiners
were able to offer participants some advice on the best way of looking after their mouth
or teeth. Dental examiners provided information for participants who wished to know
about preventing oral diseases only after participants completed the survey
questionnaire. The questionnaire included questions on health behaviours, and
providing this information before participants completed the questionnaire could lead
to potential biases. Dental examiners provided information on diet, fluorides, oral
hygiene, and tobacco consumption using the standard opening, “What I generally tell
people is…” Participants were also given a feedback letter (Appendix 7).
9
Survey Questionnaire
Participants completed an interviewer-administered survey questionnaire before their
clinical examination. Interviewers explained to participants that they were free to
withdraw from the study at any point; they could answer questions in one part but not
in a later part if they felt uncomfortable providing personal background information.
The survey questionnaire assessed socio-demographic factors, current oral pain and
urgent conditions, the impact of dental conditions on people’s quality of life, perceived
need for treatment, oral health behaviours (i.e., tooth brushing and denture cleaning,
sugar consumption and smoking and paan use); and the use of dental services. Sociodemographic factors included age, gender ethnicity, highest level of education
completed and socio-economic status based on the National Statistics Socio-economic
Classification derived from the UK 2011 Census questionnaire (23). The ethnic group
categories were revised to capture the ethnic diversity of East London and the City. Oral
health behaviours and the use of dental services were assessed using questions from
the 2009 UK Adult Dental Health Survey (9). The validated inventory Oral Health Impact
Profile-14 assessed the impact of dental conditions of older adults on the quality of life
(24). Participants’ home postcodes were used to determine an area-based measure of
deprivation─ The Index of Multiple Deprivation (IMD) 2007 (25). Socio- demographic
information included age, gender ethnicity, highest level of education completed and
socio-economic status based on the National Statistics Socio-economic Classification
(23).
Data Analysis
Data analysis included descriptive (frequency distribution) and analytic statistics. Interexaminer agreement was assessed using Kappa tests. The statistical significance of
observed differences was assessed using Chi-squared tests and Mann-Whitney tests to
compare proportions and mean scores. Logistic regression and Poisson regression
produced odds ratios (OR and prevalence rate ratios (PRR) (when prevalence estimates
were ≥30%) adjusted for age and gender (26). All analyses were weighted to adjust for
the unequal probability of selection and non-response and to represent the population
distribution related to age, gender and ethnicity reported in the Census 2001. Data
analyses also took into account the complex survey design (stratification and clustering) to
10
produce corrected standard errors and confidence intervals. The level of significance was
set at five percent. All analyses were carried out using STATA 11/IC (27).
11
5.1: Sample Description
5.1.1: Response Rate
This survey recruited 796 older adults aged 65 years and over living in East London and
the City from August 2011 to December 2011 in phase 1 of the study who completed the
survey questionnaire. The sample was drawn from a list of all addresses in the 61 wards
in City and Hackney, Tower Hamlets and Newham. We excluded commercial addresses
and vacant premises. The final sampling frame consisted of 1270 households
comprising 420 addresses in City and hackney, 403 households in Tower Hamlets and
447 addresses in Newham (Table 5.1.1.1). At least one adult to a maximum of two older
adults residing in valid addresses were invited to participate in the survey with an
average recruitment of 1.15 older adults per household in City and Hackney, 1.10 older
adults per household in Tower Hamlets and 1.11 older adults per household in
Newham. Adults in two hundred and thirty-five households living in City and Hackney,
217 adults living in Tower Hamlets and 235 adults living in Newham agreed to
households agreed to participate (Table 5.1.1.1). The response rates for City and
Hackney, Tower Hamlets and Newham were 55.9%, 53.8% and 52.6% respectively
(Table 5.1.1.1). Phase 1 included 772 adults who reported their age, gender and
ethnicity. The dataset had a high completion rate only excluding 24 older adults because
of missing questionnaire data; 16 adults did not report their date of birth and eight
adults did not report their ethnicity.
Phase 2 recruited 523 older adults who completed both the survey questionnaire and the
clinical examination.
12
Table 5.1.1.1: Household response rates for the sample of older adults living in East London and the City
(ELC) boroughs in 2011
City and
Tower Hamlets Newham
Hackney
Number of valid addresses (final sampling frame)
420
403
447
Number addresses refusing to participate
185
186
212
Number of addresses who agreed to participate
235
217
235
Household response rate (%)
55.9
53.8
52.6
13
5.1.2: Sample Representativeness
The sampling strategy adopted in this oral health survey produced a sample reflecting
the deprivation profile of older adults living in East London and the City (ELC) in 2011.
The mean Index of Multiple Deprivation (IMD) 2007 scores in the sample of older adults
living in City and Hackney (mean IMD=43.67), Tower Hamlets (mean IMD =45.89) and
Newham (mean IMD= 43.30) were comparable to the borough summary IMD 2007
scores for City and Hackney (mean IMD=44.90), Tower Hamlets (mean IMD=44.60) and
Newham (43.00) (28). Ninety‐six percent of older adults resided in the three most
deprived neighbourhood quintiles in England (Table 5.1.2.1).
Weighting the original data ensured that the final dataset was fully representative of the
population of older adults in ELC (Table 5.1.2.2). The sample comprised 43.9% males
and 56.1% females aged 65 to 95 years from a variety of ethnic origins. The largest
ethnic group was White (80.5%) (Table 5.1.2.2). Thirty-five percent of older adults lived
in City and Hackney, 33.8% lived in Newham and 31% lived in Tower Hamlets (Table
5.1.2.3).
14
Table 5.1.2.1: Frequency distribution by Index of Multiple Deprivation (IMD) 2007 quintles in England
in the sample of older adults living in East London and the City (ELC) in 2011
Range of average IMD scores in England in
IMD quartiles in England
Number
2007
1st quintile (least deprived scores)
0.00-8.32
8 (1.41)
2nd quintile
8.33-13.74
0 (0.00)
3rd
quintile
13.75-21.22
19 (2.79)
4th
quintile
21.23-34.42
89 (12.57)
5th
quintile (most deprived scores)
>34.43
656 (83.23)
All Adults
772 (100.00)
Table 5.1.2.2: Frequency distribution by age, gender, and ethnicity in the sample of older adults living in
Number (%) in
population
Number (%) in
Unweighted sample
Number(%) in
Weighted sample
Age
65-74
75-84
85 and over
33525 (55.69)
20191 (33.54)
6484 (10.77)
463 (59.36)
254 (32.56)
63 (8.08)
458 (53.66)
252 (35.69)
62 (10.65)
All Adults
60200 (100.00)
780 (100.00)
772 (100.00)
Gender
Male
Female
26688 (44.33)
33512 (55.67)
387 (48.62)
409 (51.38)
376 (43.88)
396 (56.12)
All Adults
796 (100.00)
796 (100.00)
772 (100.00)
Ethnic Group
White
Asian
Black
Mixed/Other
45953 (76.33)
6476 (10.75)
6395 (10.62)
1376 (2.29)
408 (51.91)
137 (17.43)
207 (26.34)
34 (4.33)
402 (80.15)
133 (10.32)
202 (8.37)
34 (1.16)
All Adults
796 (100.00)
786 (100.00)
772 (100.00)
Variables
Table 5.1.2.3: Frequency distribution by borough in the population in the census 2001 and in the
Number (%)of older adults in Number (%) of older adults
East London and the City (ELC) borough
the population Census 2001
in the sample in 2011
City and Hackney
20031 (33.26)
272 (35.23
Tower Hamlets
18373 (30.50)
239 (30.96)
Newham
21816 (36.22)
261 (33.81)
All Adults
772 (100.00)
15
5.1.3: Non-Response Bias for the Clinical Examination
We conducted the fieldwork for this survey in two phases with older adults first
completing the survey questionnaire in phase 1 followed by a clinical examination in
phase 2. From the 772 adults who completed the survey questionnaire, 523 adults
(67.7%) also completed the clinical examination. The reasons why some older adults
did not complete the clinical examination included death, hospitalization and relocation
to old people’s homes. Some edentulous adults declined the clinical examination
because they thought that they did not qualify for the clinical examination. Some were
suspicious and declined the clinical examination because of lack of trust while others
thought that the survey meant only completing the survey interview. Some older adults
refused the clinical examination at the examination appointment for no apparent
reason. There were also logistical problems where examiners could not arrange suitable
appointments within the time-frame of the survey. Some older adults also refused the
clinical examination because of the length of time between the interview and clinical
examination.
In order to assess the risk of possible bias caused by non-response at the survey
questionnaire and interview and examination stages, we compared the sociodemographic characteristics of adults who completed both the survey questionnaire
and clinical examination and older adults who only completed the survey questionnaire
(Table 5.1.3.1). There were no differences related to age, ethnic group or borough
between older adults who completed both the survey questionnaire and the clinical
examination and older adults who only completed the survey questionnaire (Table
5.1.3.1).
16
Table 5.1.3.1: Number (%) of older adults who completed the survey components by age, gender, ethnic
group and East London and the City (ELC) borough in the sample of older adult living in ELC in 2011
Number(%) of adults who
completed the survey
Number(%) of adults who completed
Variables
questionnaire and clinical
the survey questionnaire
examination
Age (years)
65-74
313 (54.15)
458 (53.66)
75-84
173 (36.36)
252 (35.69)
85 and over
37 (9.50)
62 (10.65)
Gender
Male
Female
272 (48.04)
251 (51.96)
376 (43.88)
396 (56.12)
Ethnic Group
White
Asian
Black
289 (82.54)
79 (9.41)
130 (8.05)
403 (81.09)
133 (10.44)
202 (8.46)
ELC borough
City and Hackney
Tower Hamlets
Newham
182 (23.04)
157 (50.77)
184 (26.18)
272 (23.09)
239 (51.17)
261 (25.75)
Older Adults
523 (100.00)
772 (100)
* Total refers to the number of older adults who completed the survey questionnaire but did not complete the clinical examination
17
5.2: Reliability of Clinical Measurements
Cohen’s Kappa statistic is a measure of agreement between clinical examiners, which
takes into account chance agreement (28). Kappa values computed for the examiners
who took part in the ELC survey of older adults assessed the level of agreement related
to their diagnoses of coronal tooth conditions (i.e., sound, decayed, missing, filled teeth
and decay experience), root surface conditions, tooth wear, plaque, calculus, bleeding,
periodontal pocketing and loss of attachment. Table 5.2.1.2 shows the mean, minimum
and maximum Kappa values for individual examiners compared to the gold standard
examiner. Kappa values between 0.81 and one indicate excellent agreement; values
between 0.61 and 0.80 indicate substantial agreement, values between 0.41 and 0.60
indicate moderate agreement and values between 0.21 and 0.40 indicate fair agreement
(29). Table 5.2.1.2 shows that examiners demonstrated excellent agreement assessing
coronal tooth conditions, moderate agreement for assessing plaque and tooth wear; and
fair agreement for assessing pocketing, loss of attachment and root surface conditions.
There was poor agreement between examiners assessing calculus and bleeding (Table
5.2.1.2).
18
Table 5.2.1.2: Kappa Statistics assessing the reliability of clinical examinations conducted in the sample
of older adults living in East London and the City (ELC) in 2011
Minimum Kappa
Maximum Kappa
Clinical Indicators
Mean Kappa Values
Values
Values
Coronal Tooth Condition 1
0.82
0.62
1.00
Root Surface Condition 2
0.34
0.02
0.74
Bleeding on probing
0.17
0.09
0.29
Visible Plaque
O.50
0.19
0.91
Calculus
0.15
0.01
0.54
Pocketing 3
0.36
0.13
0.56
Loss of Attachment 3
0.28
0.01
0.04
Tooth Wear
0.42
0.07
0.84
1 Coronal
tooth condition: (e.g., sound, decayed, filled, missing teeth)
surface condition: (e.g., unexposed, exposed but sound, decayed, filled, missing teeth)
3 Weighted Kappa values based on seven categories (i.e., 0-3mm, 4-5mm, 6-7mm, 10-11mm, unscorable and missing)
2 Root
19
5.3: Oral Health and Function
5.3.1: Total Tooth Retention
The vast majority (97.2%) of older adults living in East London and the City (ELC) had
one or more natural teeth (dentate) (Table 5.3.1.1). Less than three percent (2.8%) of
older adults had lost all their natural teeth (edentate). There was no significant
difference between the percentage of dentate male (98.8%) and female (97.7%) older
adults (Table 5.3.1.1). Neither were there significant differences between the
percentage of White, Asian and Black dentate older adults or dentate older adults living
in City and Hackney, Tower Hamlets and Newham (Table 5.3.1.1).
20
Table 5.3.1.1: Percentage of adults who had one or more natural teeth (dentate) by age, gender,
ethnicity and East London and the City (ELC) borough in the sample of older adults living in ELC in
2011
Variables
Percentage
Prevalence Rate Ratio (95% CI) p Value
Base
Age (years)
65-74
75-84
85 and over
Total
97.61
97.16
94.92
1
0.99 (0.96, 1.02)
0.97 (0.87, 1.09)
0.78
0.62
313
173
37
523
Gender
Male
Female
Total
98.76
97.73
1
0.97 (0.94, 1.00)
0.07
272
251
523
Ethnic group*
White
Asian
Black
Total
97.59
94.12
96.83
1
0.96 (0.89, 1.02)
0.99 (0.95, 1.02)
0.21
0.40
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
97.51
98.32
94.70
1
1.01 (0.98, 1.04)
0.94 (0.92, 1.03)
0.51
0.33
182
157
184
523
All Adults
97.19
*PRR adjusted for age and gender
21
5.3.2: Number and Condition of Natural Teeth
Older adults living in ELC had a mean number of 26.6 natural teeth (Table 5.3.2.1).
There were no significant age or gender differences related to the number of natural
teeth but there were ethnic group and borough differences (Table 5.3.2.1). Asian older
adults (mean=23.2 natural teeth) had significantly fewer natural teeth than Black older
adults (mean=27.5 natural teeth) and White older adults (mean=26.9 natural teeth)
(Table 5.3.2.1). Older adults living in Newham (mean=22.7 teeth) also had fewer teeth
than older adults living in City and Hackney (mean=28.0 teeth) (Table 5.3.2.1).
The presence of 21 or more teeth denotes a “functional dentition,” where people are
typically able to eat, speak and socialize without active oral disease (30). Eighty-one
percent of older adults living in ELC had a functional dentition (Table 5.3.2.2). Although
67.9% of older adults aged 85 years and over had 21 or more natural teeth compared to
82.9% of older adults aged 65-74 years, this difference was not statistically significant.
Asian older adults (66.6%) were less likely to have 21 or more teeth than Black (86.5%)
and White (82.1%) older adults (Table 5.3.2.2). Older adults living in Newham (68.2%)
were also less likely to have a functional dentition than older adults living in City and
Hackney (85.2%) (Table 5.3.2.2).
Posterior functional contacts assess contact between back (premolars and molar) teeth
in the opposing upper and lower jaws. The number of possible posterior functional
contacts ranged from zero to four. Older adults living in ELC had a mean number of 2.19
posterior functional contacts (Table 5.3.2.3). As expected, the number of posterior
contacts decreased with increasing age and increasing tooth loss. Older adults aged 7584 years (mean =2.0 contacts) and adults aged 85 years (mean =1.2 contacts) had fewer
posterior contacts than adults aged 65-74 years (mean =2.5 contacts) (Table 5.3.2.3).
Black older adults (mean=2.55 contacts) had more posterior contacts than White older
adults (mean=2.1 contacts) and Asian older adults (mean=2.1 contacts) (Table 5.3.2.3).
Similarly, older adults aged 65-74years (76.5%) and Black older adults (83.9%) were
more likely to have one or more posterior contact than older adults aged 75-84 years
(66.3%), older adults aged 85 years and over (42.1%) and White older adults (68.0%) (
Table 5.3.2.4). There were no significant gender or borough differences related to
posterior functional contacts (Table 5.3.2.3 and Table 5.3.2.4).
22
Older adults living in ELC had a mean number of 6.5 unfilled spaces in the front of the
mouth (Table 5.3.2.5). White older adults had a higher number of unfilled spaces in the
front of their mouths (mean=6.7 spaces) than Black older adults (mean=5.3 spaces)
(Table 5.3.2.5). Eighty-two percent of older adults had one or more unfilled space in the
front of their mouth (Table 5.3.2.6). Older adults aged 75-84 years (92.9%) and older
adults aged 85 years and over (89.8%) were more likely to have unfilled spaces than
older adults aged 65-74 years (72.7%) (Table 5.3.2.6)
Older adults living in ELC had a mean number of 9.7 sound and untreated teeth (Table
5.3.2.7 ). Unsurprisingly, older adults who were aged 65-74 years had more sound teeth
(mean = 11.5 teeth) than older adults aged 75-84 years (mean=7.9 teeth) (Table
5.3.2.7). Even though Asian older adults had fewer natural teeth than White older adults
(Table 5.3.2.1), Asian older adults (mean=11.3 sound teeth) and Black older adults
(mean=16.5 sound teeth) had more sound and untreated teeth than White older adults
(mean=8.9 teeth) (Table 5.3.2.7). Thirteen percent of older adults living in ELC had 18
or more sound and untreated teeth (Table 5.3.2.8). White older adults (8.2%) were also
less likely to have 18 or more sound teeth than Asian older adults (26.9%) and Black
older adults (48.5%) (Table 5.3.2.8). There were no differences between the percentage
of females and males and older adults living in City and Hackney, Tower Hamlets and
Newham, who had 18 or more sound teeth (Table 5.3.2.8).
23
Table 5.3.2.1: Mean number of teeth by age, gender, ethnicity and East London and the City (ELC)
Variables
Mean
Base
Age (years)
65-74
75-84
85 and over
Total
26.87
26.88
24.37
1
1.00 (0.93, 1.07)
0.91 (0.72, 1.140
0.99
0.40
313
173
37
523
Gender
Male
Female
Total
27.31
26.01
1
0.95 (0.89, 1.02)
0.16
272
251
523
Ethnic group*
White
Asian
Black
Total
26.94
23.17
27.50
1
0.86 (0.77, 0.97)
1.02 (0.96, 1.08)
0.01
0.51
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
28.02
28.03
22.72
1
1.00 (0.93, 1.07)
0.81 (0.75, 0.88)
0.98
<0.001
182
157
184
523
All Adults
26.64
* Means adjusted by age and gender
Table 5.3.2.2: Percentage of adults with 21 or more teeth by age, gender, ethnicity and East London and
the City (ELC) borough in the sample of older adults living in ELC in 2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
82.89
81.50
67.86
1
0.98 (0.910, 1.07)
0.81 (0.57, 1.17)
0.70
0.27
313
173
37
523
Gender
Male
Female
Total
83.10
79.98
1
0.95 (0.86, 1.05)
0.33
272
251
523
Ethnic group*
White
Asian
Black
Total
82.14
66.60
86.54
1
0.79 (0.65, 0.94)
1.03 (0.95, 1.11)
0.01
0.52
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
85,22
85.58
68.25
1
1.01 (0.92, 1.13)
0.81 (0.72, 0.91)
0.72
0.001
182
157
184
523
All Adults
80.96
#PRR
adjusted for age and gender
24
Table 5.3.2.3: Mean number of posterior functional contacts by age, gender, ethnicity and East London
and the City (ELC) borough in the sample of older adults living in ELC in 2011
Variables
Mean
Base
Age (years)
65-74
75-84
85 and over
Total
2.51
1.96
1.19
1
0.78 (0.64, 0.95)
0.47 (0.24, 0.93)
0.01
0.03
313
173
37
523
Gender
Male
Female
Total
2.20
2.17
1
0.99 (0.85, 1.13)
0.85
272
251
523
Ethnic group*
White
Asian
Black
Total
2.15
2.12
2.55
1
0.99 (0.81, 1.20)
1.17 (1.02, 1.34)
0.89
0.02
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
2.43
2.14
2.05
1
0.88 (0.72, 1.08)
0.85 (0.67, 1.07)
0.22
0.17
182
157
184
523
All Adults
2.19
* PRR adjusted for age and gender
Table 5.3.2.4: Percentage of adults with one or more posterior functional contacts by age, gender,
2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
*
76.49
66.34
42.06
1
0.88 (0.75, 1.00)
0.55 (0.34, 0.90)
0.05
0.02
313
173
37
523
Gender
Male
Female
Total
71.24
67.95
1
0.95 (0.82, 1.11)
0.54
272
251
523
Ethnic group*
White
Asian
Black
Total
67.52
73.76
83.87
1
1.01 (0.85, 1.21)
1.16 (1.04, 1.30)
0.88
0.008
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
74.82
70.31
63.36
1
0.97 (0.83, 1.14)
0.86 (0.71, 1.04)
0.72
0.12
182
157
184
523
All Adults
69.53
PRR adjusted for age and gender
25
Table 5.3.2.5: Mean number of spaces in the front of the mouth (anterior and premolar teeth) by age,
gender, ethnicity and East London and the City (ELC) borough in the sample of older adults living in
ELC in 2011
Variables
Mean
Prevalence Rate Ratio (95% CI)
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
5.16
7.85
9.76
1
1.52 (1.18, 1.95)
1.89 (1.32, 2.69)
0.001
0.001
313
173
37
523
272
Gender
Male
Female
Total
6.00
7.11
Ethnic group*
White
Asian
Black
Total
6.68
6.78
5.29
1
1.01 (0.75, 1.38)
0.77 (0.60, 0.98)
0.90
0.04
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
6.70
5.77
8.03
1
0.86 (0.67, 1.11)
1.20 (0.92, 1.56)
0.24
0.17
182
157
184
523
All Adults
6.58
1
1.19 (0.98, 1.43)
251
0.08
523
*Means and PRR adjusted for age and gender
Table 5.3.2.6: Percentage of adults with spaces in the front of the mouth (anterior and premolar teeth)
by age, gender, ethnicity and East London and the City (ELC) borough in the sample of older adults
Variables
Mean
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
72.69
92.90
89.81
1
1.28 (1.16, 1.40)
1.23 (1.01, 1.51)
<0.001
0.04
313
173
37
523
Gender
Male
Female
Total
78.82
84.29
1
1.07 (0.98, 1.17)
0.14
272
251
523
Ethnic group*
White
Asian
Black
Total
83.70
71.82
73.83
1
0.92 (0.80, 1.05)
0.94 (0.83, 1.06)
0.21
0.32
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
76.99
82.22
84.70
1
1.06 (0.93, 1.20)
1.10 (0.97, 1.26)
0.38
0.14
182
157
184
523
All Adults
81.66
26
Table 5.3.2.7: Mean number of sound and untreated teeth by age, gender, ethnicity and East London and
Variables
Mean
Base
Age (years)
65-74
75-84
85 and over
Total
11.49
7.91
6.63
1
0.69 (0.59, 0.80)
0.58 (0.40, 0.83)
<0.001
<0.004
313
173
37
523
272
Gender
Male
Female
Total
10.35
9.15
Ethnic group*
White
Asian
Black
Total
8.85
11.34
16.50
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
9.14
9.83
10.05
All Adults
9.73
1
0.88 (0.78, 0.99)
0.05
251
523
289
1
1.27 (1.04, 1.53)
1.81 (1.62, 2.01)
0.02
<0.001
79
130
498
182
1
1.07 (0.91, 1.26)
1.10 (0.91, 1.32)
0.39
0.33
157
184
313
523
* Means adjusted for age and gender
Table 5.3.2.8: Percentage of adults with 18 or more sound and untreated teeth by age, gender, ethnicity
and East London and the City (ELC) borough in the sample of older adults living in ELC in 2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
19.83
6.26
4.05
1
0.32 (0.15, 0.64)
0.20 (0.03, 1.48)
0.002
0.12
313
173
37
523
Gender
Male
Female
Total
15.99
11.00
1
0.69 (0.43, 1.12)
0.12
272
251
Ethnic group*
White
Asian
Black
Total
8.24
26.92
48.48
1
2.53 (1.22, 5.25)
4.66 (2.92, 7.43)
0.01
<0.001
289
79
130
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
9.88
12.70
17.95
1
1.36 (0.73, 2.53)
1.82 (0.98, 3.36)
0.32
0.06
182
157
184
All Adults
13.40
27
5.3.3: Denture Use
Nearly half (47.4%) of older adults living in ELC wore dentures (Table 5.3.3.1). A higher
percentage of older adults aged 75-84 years (55.8%) wore dentures than older adults
aged 65-74 years (38.6%) (Table 5.3.3.1). Female older adults (51.6%) were more likely
to be denture wearers than male older adults (42.0%) (Table 5.3.3.1). There were no
significant ethnic group or borough differences related to denture wearing (Table
5.3.3.1). Fifty-five percent of the dentures identified during the clinical examination
were partial dentures, 30% were complete dentures, 10.6% were paired partial and
complete dentures and 4.2% were paired upper and lower complete dentures (Table
5.3.3.2). Most (85.7%) dentures were acrylic dentures; seven percent were metal and
seven percent were paired metal and acrylic dentures (Table 5.3.3.3). Nineteen percent
of the dentures worn by older adults were in need of repair (Table 5.3.3.4).
28
Table 5.3.3.1: Number of adults with dentures by age, gender, ethnicity and East London and the City
Variables
Percentage of adults Prevalence Rate Ratio (95% CI) p Value
Base
who reported
wearing dentures
Age (years)
65-74
38.57
1
453
75-84
55.86
1.45 (1.11, 1.89)
0.008
249
85 and over
63.01
0.89 (0.76, 1.03)
0.12
62
Total
764
Gender
Male
Female
Total
41.97
51.58
1
1.23 (1.01, 1.49)
0.04
371
393
764
Ethnic group*
White
Asian
Black
Total
49.44
33.85
42.66
1
0.78 (0.55, 1.08)
0.97 (0.78, 1.19)
0.13
0.77
401
132
197
730
ELC borough*
City and Hackney
Tower Hamlets
Newham
43.91
50.49
44.36
1
1.09 (0.82, 1.43)
1.00 (0.75, 1.33)
0.53
0.98
All Adults
47.39
267
237
260
Table 5.3.3.2: Number (%) of denture types in the sample of older adults living in East London and the
City (ELC) in 2011
Denture Type
Number (%)
Partial Denture
Complete Denture
Partial/Complete
Complete/Complete
133 (55.07)
73 (30.10)
24 (10.59)
15 (4.23)
All Adults*
245 (100.00)
*Total refers to adults wearing dentures
Table 5.3.3.3. Number (%) of dentures by denture material in the sample of older adults living in East
Denture Material Type
Number (%)
Metal Denture
Acrylic Denture
Metal and Acrylic Denture
22 (7.17)
206 (85.74)
16 (7.08)
All Adults*
244 (100.00)
Table 5.3.3.4. Number (%) of dentures requiring repair in the sample of older adults living in East
Denture Status
Number (%)
Intact Denture
Denture in need of repair
193 (80.79)
47(19.21)
All Adults*
240 (100.00)
29
5.4: Disease and Related Disorders
5.4.1: Dental Caries Experience
Dental decay experience assesses past and present tooth decay (dental caries). It
includes active (untreated) decayed teeth and filled and extracted decayed teeth. Older
adults living in ELC had relatively few untreated decayed teeth with a mean number of
0.52 untreated decayed teeth (Table 5.4.1.1). Female older adults had fewer untreated
decayed teeth (mean=0.4 decayed teeth) than male older adults (mean=0.7 decayed
teeth) (Table 5.4.1.1). A quarter (24.9%) of older adults had one or more untreated
decayed tooth (Table 5.4.1.2). Older adults aged 75-84 years (31.4%) were more likely
to have untreated decayed teeth than older adults aged 65-74 years (18.9%) (Table
5.4.1.2). There were no significant ethnic group or borough differences related to
untreated decayed teeth (Table 5.4.1.2).
Older adults living in ELC had a mean number of 5.4 missing teeth (Table 5.4.1.3). There
was a significant borough difference with older adults living in Newham (mean=13.7
missing teeth) having more missing teeth than older adults living in City and Hackney
(mean=10.3 missing teeth) (Table 5.4.1.3). Forty percent of older adults had one or
more missing tooth (Table 5.4.1.4). Asian older adults (60.5%) and older adults living in
Newham (69.8%) were more likely to have teeth missing than White older adults
(37.1%) and adults living in City and Hackney (34.3%) (Table 5.4.1.4).
Older adults living in ELC had a mean number of 5.2 filled teeth (Table 5.4.1.5). Asian
older adults (mean=2.1 filled teeth) and Black older adults (mean=3.2 filled teeth) had
significantly fewer filled teeth than White older adults (mean=5.8 filled teeth). The fact
that Asian older adults also had fewer natural teeth than White older adults (Table
5.3.2.1) may possibly suggest that Asian older adults were more likely to have had their
teeth extracted rather than filled. Older adults living in Newham also had fewer filled
teeth (mean=4.0 filled teeth) than older adults living in City and Hackney (mean=5.8
filled teeth) (Table 5.4.1.5). Most (84%) older adults had filled teeth. White older adults
(87.1%) and older adults living in City and Hackney (85.7%) were more likely to have
filled teeth than Asian older adults (63.7%) and Black older adults (75.6%) and older
adults living in Newham (70.9%) (Table 5.4.1.6).
30
Older adults living in ELC had a mean number of 11.1 teeth with decay (caries)
experience (Table 5.4.1.7). Black older adults (mean DMFT=8.2) had significantly fewer
teeth with decay experience than White older adults (mean DMFT=11.4) (Table 5.4.1.7).
Older adults living in Newham (mean DMFT=13.7) had significantly more teeth with
decay experience than older adults living in City and Hackney (mean DMFT=10.3)
(Table 5.4.1.7). Most (95%) older adults had decay experience (Table 5.4.1.8). Asian
older adults (83.4%) were less likely to have had decay experience than White older
adults (97.0%) and Black older adults (93.4%) (Table 5.4.1.8).
31
Table 5.4.1.1: Mean number of untreated decayed teeth into dentine by age, gender, ethnicity and East
London and the City (ELC) borough in the sample of older adults living in ELC in 2011
Variables
Mean
Base
Age (years)
65-74
75-84
85 and over
Total
0.45
0.56
0.83
1
1.25 (0.69, 2.27)
1.87 (0.66, 5.23)
0.45
0.23
313
173
37
523
Gender
Male
Female
Total
0.70
0.36
1
0.51 (0.28, 0.92)
0.03
272
251
523
Ethnic group*
White
Asian
Black
Total
0.53
0.49
0.55
1
0.92 (0.42, 2.00)
1.04 (0.54,2.00)
0.83
0.91
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
0.51
0.59
0.41
1
1.17 (0.59, 2.30)
0.79 (0.38, 1.63)
0.65
0.52
182
157
184
523
All Adults
0.52
Table 5.4.1.2: Percentage of adults with one or more untreated decayed tooth into dentine age, gender,
2011
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
*
18.87
31.43
34.39
1
1.97 (1.10, 3.52)
2.25 (0.64, 7.95)
0.02
0.20
313
173
37
523
Gender
Male
Female
Total
29.62
20.55
1
0.61 (0.32, 1.18)
0.14
272
251
523
Ethnic group*
White
Asian
Black
Total
25.20
20.28
25.73
1
0.91 (0.43, 1.91)
1.20 (0.59, 2.42)
0.79
0.61
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
23.15
27.14
22.12
1
1.23 (0.64, 2.35)
1.00 (0.50, 1.98)
0.53
0.99
182
157
184
523
All Adults
24.91
32
Table 5.4.1.3: Mean number of missing teeth by age, gender, ethnicity and East London and the City
Variables
Mean
Base
Age (years)
65-74
75-84
85 and over
Total
11.32
10.63
11.75
1
1.00 (0.69, 1.44)
1.49 (0.70, 3.15)
0.99
0.29
313
173
37
523
Gender
Male
Female
Total
10.45
11.73
1
1.28 (0.92, 1.77)
0.14
272
251
523
Ethnic group*
White
Asian
Black
Total
11.37
11.41
8.20
1
1.80 (1.26, 2.56)
0.88 (0.60, 1.30)
0.001
0.52
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
10.32
10.15
13.67
1
1.01 (0.60, 1.69)
2.35 (1.55, 3.55)
0.97
<0.001
All Adults
5.36
182
157
184
Table 5.4.1.4: Percentage of adults with one or more missing tooth by age, gender, ethnicity and East
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
41.88
36.37
39.64
1
0.87 (0.61, 1.22)
0.95 (0.51, 1.74)
0.42
0.86
313
173
37
523
Gender
Male
Female
Total
36.86
42.25
1
1.15 (0.86, 1.52)
0.34
272
251
523
Ethnic group*
White
Asian
Black
Total
37.10
60.53
41.74
1
1.62 (1.24, 2.11)
1.12 (0.82, 1.53)
0.001
0.46
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
34.30
26.58
69.76
1
0.77 (0.51, 1.16)
2.00 (1.43, 2.81)
0.21
<0.001
182
157
184
523
All Adults
39.67
33
Table 5.4.1.5: Mean number of filled teeth by age, gender, ethnicity and East London and the City (ELC)
Variables
Mean
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
5.75
4.94
3.29
1
0.86 (0.71, 1.04)
0.57 (0.37, 0.89)
0.12
0.02
313
173
37
523
Gender
Male
Female
Total
5.06
5.38
1
1.06 (0.90, 1.26)
0.46
272
251
523
Ethnic group*
White
Asian
Black
Total
5.80
2.10
3.16
1
0.40 (0.30, 0.55)
0.57 (0.46, 0.71)
<0.001
<0.001
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
5.83
5.60
3.97
1
0.96 (0.75, 1.24)
0.68 (0.53, 0.88)
0.77
0.004
182
157
184
523
All Adults
5.23
Table 5.4.1.6: Percentage of adults with filled teeth by age, gender, ethnicity and East London and the
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
Gender
Male
Female
Total
Ethnic group*
White
Asian
Black
Total
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
All Adults
85.87
86.23
65.06
1
1.00 (0.92, 1.10)
0.76 (0.56, 1.02)
0.92
0.07
313
173
37
85.26
82.88
1
0.97(0.89, 1.06)
0.51
272
251
523
87.09
63.67
75.55
1
0.70 (0.56, 0.89)
0.84 (0.74, 0.95)
0.004
0.005
289
79
130
498
85.68
90.03
70.94
1
1.07 (0.98, 1.16)
0.84 (0.73, 0.96)
0.11
0.01
182
157
184
523
84.02
*PRR adjusted for age and gender
34
Table 5.4.1.7: Mean number of teeth with caries experience (DMFT) by age, gender, ethnicity and East
Variables
Mean
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
Gender
Male
Female
Total
Ethnic group*
White
Asian
Black
Total
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
All Adults
11.32
10.62
11.75
1
0.94 (0.78, 1.12)
1.03 (0.68, 1.58)
0.48
0.86
313
173
37
523
10.44
11.72
1
1.12 (0.96, 1.32)
0.15
272
251
523
11.38
11.41
8.20
1
1.00 (0.79, 1.28)
0.72 (0.60, 0.87)
0.98
0.001
289
79
130
523
10.32
10.15
13.67
1
0.98 (0.89, 1.23)
1.32 (1.08, 1.62)
0.89
0.007
182
157
184
523
11.11
Table 5.4.1.8: Percentage of adults with caries experience (DMFT>0) by age, gender, ethnicity and East
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
95.51
94.85
97.33
1
0.99 (0.84, 1.04)
1.01 (0.96, 1.09)
95.33
1
95.54
1.00 (0.96, 1.05)
0.93
Ethnic group*
White
Asian
Black
Total
97.00
83.35
93.42
1
0.86 (0.74, 0.99)
0.96 (0.90, 1.02)
0.03
0.16
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
94.44
96.32
94.62
1
1.02 (0.96, 1.08)
1.00 (0.93, 1.08)
0.56
0.99
182
157
184
523
All Adults
95.44
Gender
Male
Female
Total
0.79
0.55
313
173
37
523
272
251
523
35
5.4.2: Root Surface Conditions
The survey assessed the root surfaces of teeth to identify root exposure, wear, decayed
and filled root surfaces (13). Most (93%) older adults living in ELC had teeth with
exposed root surfaces (Table 5.4.2.1). One in five (20.4%) older adults had teeth with
worn root surfaces, 38.1% had teeth with filled root surfaces and 18.0% of older adults
had teeth with untreated decayed root surfaces (Table 5.4.2.1).
Older adults living in ELC had a mean number of 13.4 teeth with exposed root surfaces
(Table 5.4.2.2), which equates to approximately half of older adults’ remaining teeth
having exposed root surfaces. Older adults aged 65-74 years (mean=15.5 root exposed
teeth) and Black older adults (mean=16.3 exposed teeth) had the most teeth with
exposed root surfaces (Table 5.4.2.2). Older adults living in City and Hackney
(mean=14.1 exposed teeth) also had significantly more teeth with exposed root surfaces
than older adults living in Newham.
Older adults living in ELC had a mean number of 0.3 teeth with untreated decayed root
surfaces. The mean number of teeth with untreated decayed root surfaces increased
with age (Table 5.4.2.2). While 11.8% of older adults aged 65-74 years had one or more
teeth with untreated decayed root surfaces, nearly a third (31.3%) of older adults aged
85 years and over had teeth with untreated decayed root surfaces (Table 5.4.2.5). There
were no gender, ethnic group or borough differences related to the untreated decayed
root surfaces (Table 5.4.2.4 and Table 5.4.2.5).
36
Table 5.4.2.1: Percentage of adults with exposed, worn, filled, and decayed root surfaces in the sample
of older adults living in ELC in 2011
Condition of Root Surfaces
Percentage
Base
Exposed root surfaces
Worn root surfaces
Filled root surfaces
Untreated decayed root surfaces
92.97
20.41
38.08
18.05
523
523
523
523
Table 5.4.2.2: Mean number of teeth with exposed root surfaces by age, gender, ethnicity and East
Variables
Mean
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
15.52
11.45
8.14
1
0.74 (0.65, 0.84)
0.52 (0.35, 0.80)
<0.001
0.003
313
173
37
523
Gender
Male
Female
Total
13.70
13.02
1
0.95 (0.84, 1..07)
0.41
272
251
523
Ethnic group*
White
Asian
Black
Total
13.27
11.22
16.31
1
0.86 (0.74, 0.99)
1.21 (1.10, 1.33)
0.05
<0.001
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
14.15
13.84
11.67
1
0.98 (0.84, 1.14)
0.83 (0.70, 0.98)
0.79
0.02
182
157
184
523
All Adults
13.35
37
Table 5.4.2.3: Percentage of adults with teeth with exposed root surfaces by age, gender, ethnicity and
East London and the City (ELC) borough in the sample of older adults living in ELC in 2011
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
93.68
93.86
85.49
1
1.00 (0.94, 1.07)
0.91 (0.79, 1.05)
0.95
0.22
313
173
37
523
Gender
Male
Female
Total
95.41
90.72
1
0.95 (0.91, 0.99)
0.03
272
251
523
Ethnic group*
White
Asian
Black
Total
92.81
91.11
96.60
1
0.97 (0.89, 1.06)
1.03 (0.98, 1.08)
0.50
0.24
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
96.91
95.27
85.03
1
0.99 (0.95, 1.03)
0.88 (0.82, 0.96)
0.66
0.003
182
157
184
523
All Adults
92.87
*OR adjusted for age and gender
Table 5.4.2.4: Mean number of teeth with untreated decayed root surfaces by age, gender, ethnicity and
Variables
Mean
Base
Age (years)
65-74
75-84
85 and over
Total
0.21
0.39
0.55
1
1.83 (0.83, 4.04)
2.57 (1.09, 6.06)
0.13
0.03
313
173
37
523
Gender
Male
Female
Total
0.42
0.21
1
0.50 (0.28, 0.91)
0.02
272
251
523
Ethnic group*
White
Asian
Black
Total
0.31
0.36
0.28
1
1.21 (0.61, 2.44)
0.89 (0.42, 1.90)
0.57
0.77
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
0.40
0.30
0.25
1
0.77 (0.37, 1.58)
0.60 (0.27, 1.33)
0.47
0.21
182
157
184
523
All Adults
0.31
38
Table 5.4.2.5: Percentage of adults with untreated decayed root surfaces by age, gender, ethnicity and
Variables
Percentage
Odds Ratio (95% CI)
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
11.84
23.85
31.27
1
2.33 (0.98, 5.56)
2.29 (1.37, 8.35)
0.06
0.009
313
173
37
523
Gender
Male
Female
Total
21.35
14.99
1
0.65 (0.33, 1.30)
0.22
272
251
523
Ethnic group*
White
Asian
Black
Total
18.41
20.95
9.90
1
1.59 (0.69, 3.71)
0.60 (0.27, 1.33)
0.27
0.21
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
21.82
19.96
11.02
1
0.84 (0.32, 2.18)
0.44 (0.18, 1.07)
0.72
0.18
182
157
184
523
All Adults
18.05
39
5.4.3: Periodontal Conditions
The presence of bleeding on probing, periodontal pocketing and loss of attachment
assess the condition of the periodontal structures (e.g. gums and bone) that support and
maintain natural teeth. Forty-seven percent of older adults living in ELC showed signs of
bleeding on probing indicating gingivitis (gum inflammation) (Table 5.4.3.1). Older
adults living in Newham (55.0%) were more likely to show signs of bleeding than adults
living in City and Hackney (38.4%) (Table 5.4.3.1). There were no significant age,
gender or ethnic group differences related to bleeding gums (Table 5.4.3.1).
Fifty-eight percent of older adults living in ELC had teeth in one or more sextants with
pocketing of 4mm or more and 67.3% of older adults had teeth in one or more sextants
with loss of attachment of 4mm or more (Table 5.4.3.2 and Table 5.4.3.3). There were
no significant age, gender, or ethnic group differences related to pocketing and loss of
attachment of 4mm or more (Table 5.4.3.2 and Table 5.4.3.3). However, older adults
living in Newham (55.9%) were less likely to have one or more sextants with loss of
attachment of 4mm or more than older adults living in Tower Hamlets (70.2%) and
older adults living in City and Hackney (73.7%) (Table 5.4.3.3).
Eighteen percent of older adults living in ELC had one or more sextants with teeth with
pocketing of 6mm or more and 25.3% of older adults had one or more sextants with
loss of attachment of 6 mm or more indicative of more severe periodontal disease
(Table 5.4.3.4 and Table 5.4.3.5). Older adults aged 75-84 years (34.8%) were more
likely to have loss of attachment of 6mm or more than older adults aged 65-74 years
(18.7%) (Table 5.4.3.5). Asian older adults (31.0%) were more likely to have pocketing
of 6mm or more than White older adults (15.8%) (Table 5.4.3.4). Older adults living in
Newham (15.3%) and older adult living in Tower Hamlets (24.8%) were less likely to
have loss of attachment of 6mm or more than older adults living in City and Hackney
(37.7%) (Table 5.4.3.5).
Sixty-four percent of older adults living in ELC had visible plaque on one or more teeth
(Table 5.4.3.6). Seventy-two percent of older adults had calculus present on one or more
teeth (Table 5.4.3.7). There were no significant age, gender, ethnic group or borough
differences related to visible plaque and detectable calculus (Table 5.4.3.6 and Table
5.4.3.7).
40
Table 5.4.3.1: Percentage of adults who had teeth in one or more sextants with bleeding by age, gender,
2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
46.98
51.87
33.27
1
1.10 (0.84, 1.45)
0.71 (0.36, 1.38)
0.47
0.30
313
173
37
523
Gender
Male
Female
Total
46.50
48.34
1
1.04 (0.84, 1.28)
0.71
272
251
523
Ethnic group*
White
Asian
Black
Total
47.15
49.87
48.35
1
1.05 (0.78, 1.41)
1.03 (0.81, 1.30)
0.73
0.83
289
79
130
523
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
38.36
47.70
54.99
1
1.37 (0.90, 1.80)
1.47 (1.07, 2.02)
0.17
0.02
182
157
184
523
All Adults
47.46
* PRR
Table 5.4.3.2: Percentage of adults who had teeth in one or more sextants with pocketing 4mm or more
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
59.85
58.18
48.80
1
0.97 (0.78, 1.20)
0.82 (0.50, 1.32)
0.79
0.40
313
173
37
523
59.97
56.83
1
0.95 (0.75, 1.21)
0.68
272
251
523
56.03
68.63
68.48
1
1.20 (0.89, 1.63)
1.20 (1.00, 1.45)
0.22
0.05
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
63.27
55.32
59.29
1
0.86 (0.73, 1.08)
0.95(0.76, 1.18)
0.22
0.62
182
157
184
523
All Adults
58.19
Gender
Male
Female
Total
Ethnic group*
White
Asian
Black
*
41
Table 5.4.3.3: Percentage of adults who had teeth in one or more sextants with loss of attachment 4mm
or by age, gender, ethnicity and East London and the City (ELC) borough in the sample of older adults
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
66.16
69.30
65.63
1
1.05 (0.85, 1.30)
0.99 (0.72, 1.37)
0.67
0.96
313
173
37
523
Gender
Male
Female
Total
71.05
63.74
1
0.90 (0.78, 1.03)
0.12
272
251
523
Ethnic group*
White
Asian
Black
Total
66.16
74.06
70.19
1
1.12 (0.94, 1.35)
1.06 (0.90, 1.25)
0.20
0.45
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
73.67
70.20
55.88
1
0.96 (0.83, 1.11)
0.77 (0.63, 0.93)
0.54
0.009
182
157
184
523
All Adults
67.25
* PRR
Table 5.4.3.4: Percentage of adults who had teeth in one or more sextants with pocketing 6mm or more
Variables
Percentage
Odds Ratio (95% CI)
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
*
18.97
15.90
18.07
1
0.81(0.40, 1.61)
0.94 (0.24, 3.67)
0.54
0.93
313
173
37
523
Gender
Male
Female
Total
17.91
17.64
1
0.98 (0.51, 1.88)
0.95
272
251
523
Ethnic group*
White
Asian
Black
Total
15.80
30.97
22.51
1
2.37 (1.11, 5.10)
1.54 (0.81, 2.92)
0.03
0.18
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
17.20
16.43
20.87
1
0.95 (0.48, 1.86)
1.26 (0.67, 1.37)
0.87
0.47
182
157
184
523
All Adults
17.77
OR adjusted for age and gender
42
Table 5.4.3.5: Percentage of adults who had teeth in one or more sextants with loss of attachment 6mm
or more by age, gender, ethnicity and East London and the City (ELC) borough in the sample of older
Variables
Percentage
Odds Ratio (95% CI)
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
*
18.69
34.77
26.48
1
2.32 (1.35, 4.00)
1.57 (0.54, 4.52)
0.003
0.40
313
173
37
523
Gender
Male
Female
Total
24.94
25.59
1
1.03 (0.58, 1.84)
0.90
272
251
523
Ethnic group*
White
Asian
Black
Total
24.59
30.13
27.18
1
1.71 (0.82, 3.54)
1.43 (0.80, 2.58)
0.15
0.23
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
37.70
24.77
15.33
1
0.52 (0.31, 0.87)
0.30 (0.15, 0.59)
0.02
0.001
182
157
184
523
All Adults
25.28
OR adjusted for age and gender
Table 5.4.3.6: Percentage of adults with visible plaque on one or more teeth by age, gender, ethnicity
Variables
Percentage
Prevalence Rate Ratio (95% CI) P
Base
Value
Age (years)
65-74
75-84
85 and over
Total
57.96
69.96
74.13
1
1.21 (1.00, 1.46)
1.28 (0.95, 1.71)
0.06
0.10
313
173
37
523
Gender
Male
Female
Total
66.69
61.24
1
0.92 (0.77, 1.09)
0.32
272
251
523
Ethnic group*
White
Asian
Black
Total
64.81
56.65
62.15
1
0.92 (0.71, 1.19)
1.00 (0.83, 1.21)
0.53
0.99
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
63.16
71.32
50.01
1
1.12 (0.89, 1.40)
0.80 (0.62, 1.02)
0.32
0.07
182
157
184
523
All Adults
63.86
* PRR
43
Table 5.4.3.7: Percentage of adults who had teeth in one or more sextants with calculus by age, gender,
2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
72.64
73.28
62.02
1
1.00 (0.86, 1.16)
0.90
Gender
Male
Female
Total
72.56
71.23
1
0.98 (0.84, 1.14)
0.81
272
251
523
Ethnic group*
White
Asian
Black
Total
72.62
62.76
73.96
1
0.85 (0.66, 1.09)
1.00 (0.87, 1.16)
0.20
0.98
289
79
130
523
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
71.19
78.95
58.73
1
1.12 (0.96, 1.31)
0.83 (0.68, 1.01)
0.15
0.07
182
157
184
523
All Adults
71.84
* PRR
313
173
37
523
44
5.4.4: Tooth Wear
This survey followed the 2009 Adult Dental Health Survey (9) and assessed tooth wear
in older adults. Examiners assessed wear on three surfaces on six upper anterior (front)
teeth: the outer surfaces (buccal), the inner surfaces (palatal) and the cutting surfaces
(incisal). Examiners also scored the worst affected surface on the six lower anterior
(front) teeth. Twenty four sites were assessed for tooth wear.
Older adults living in ELC had a mean number of 6.31 sites showing signs of enamel
wear just exposing dentine, a mean of 1.60 sites with enamel/dentine wear exposing
more than a third of the tooth surface and a mean of 0.37 sites with evidence of wear
involving the dentine/pulp complex (Table 5.4.4.1). Forty-nine percent of older adults
had the worst recorded wear involving loss of enamel just exposing dentine teeth,
34.5% had the worst recorded wear involving enamel/dentine exposing more than a
third of the tooth surface and 11.82% had the worst recorded involving the
dentine/pulp complex (Table 5.4.4.2 and Table 5.4.4.2). Older adults aged 85 years and
over (66.6%) were more likely to have enamel/dentine wear and wear involving the
dentine/pulp complex than older adults aged 65-74 years (45.5%) (Table 5.4.4.3).
There were no significant gender, ethnic group and borough differences related to the
worst recorded tooth wear (Table 5.4.4.3).
45
Table 5.4.4.1: Mean number of sites with enamel wear, enamel/dentine wear and wear involving the
dentine/pulp complex by age, gender, ethnicity and East London and the City (ELC) borough in the
Variables
Mean number of
Mean number of
Mean number of sites
Base
sites with enamel sites with
with wear involving
just exposing
enamel/dentine
the dentine/pulp
dentine wear
wear*
complex
Age (groups
65-74
75-84
85 and over
Total
7.25
5.50
4.11
1.59
1.59
1.69
0.36
0.31
0.61
292
160
32
484
Gender
Male
Female
Total
6.26
6.37
1.91
1.32
0.42
0.31
253
231
484
Ethnic group*
White
Asian
Black
Total
6.15
6.77
7.57
1.56
2.10
1.44
0.34
0.56
0.43
289
79
130
498
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
6.61
6.21
6.26
1.16
1.65
1.91
0.29
0.48
0.21
170
150
164
484
All Adults
6.31
1.60
0.37
* Loss of enamel exposing dentine for more than a third of the tooth surface
Table 5.4.4.2: Number (%) of adults with tooth wear based on the worst score recorded at the 24 sites
in the sample of older adults living in East London and the City (ELC) in 2011
Worst score
Number (%)
Sound/wear restricted to enamel
19 (4.61)
Enamel just exposing dentine
243 (49.09)
Enamel/dentine wear exposing more than a third of the surface
173 (34.48)
Wear involving dentine/pulp complex
49 (11.82)
All Adults
484 (100.00)
46
Table 5.4.4.3: Percentage of adults who had enamel/dentine wear and wear involving the dentine/pulp
complex as their worst recorded score on the 24 sites by age, gender, ethnicity and East London and
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
45.54
42.89
66.64
1
0.94 (0.67, 1.32)
1.46 (1.02, 2.08)
0.72
0.04
292
160
32
484
Gender
Male
Female
Total
51.06
41.75
1
0.82 (0.64, 1.03)
0.10
253
231
484
Ethnic group*
White
Asian
Black
Total
46.59
52.77
36.76
1
1.15 (0.78, 1.69)
0.79 (0.59 , 1.06)
0.48
0.12
268
70
125
463
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
41.84
46.58
49.92
1
1.08 (0.77, 1.52)
1.20 (0.87, 1.66)
0.77
0.27
170
150
164
484
All Adults
46.30
47
5.5: Urgent Conditions
5.5.1: PUFA symptoms
The PUFA is a newly developed index that assesses the consequences of advanced tooth
decay that require immediate attention (10). Symptoms include: (i) pulpal involvement
of a tooth with an opened pulp chamber or the complete destruction of the crown of a
tooth leaving root remnants; (ii) ulceration from a decayed or dislocated tooth or root
fragment traumatizing the surrounding soft tissues; (iii) the presence of a fistula ─ a
pus-releasing sinus tract associated with a decayed tooth and; (iv) an abscess ─ a pusfilled swelling associated with a decayed tooth.
Four percent of older adults living in ELC had one or more ulcer associated with a
decayed tooth. Three percent (2.8%) of older adults teeth had open pulps, 1.5% had a
fistula and 0.5% had a abscess (Table 5.5.1.1). Eight percent of older adults had one or
more PUFA symptoms (Table 5.5.1.2). There were no significant age, gender, ethnic
group or borough differences related to having any PUFA symptoms (Table 5.5.1.2).
48
Table 5.5.1.1: Number (%) of adults with individual PUFA symptoms in the sample of older adults living
in East London and the City (ELC) in 2011
PUFA symptoms
Number (%)
Base
Open pulp
10 (2.76)
506
Ulceration
18 (4.08)
507
Fistula
9 (1.47)
506
Abscess
6 (0.51)
505
43 (8.39)
Table 5.5.1.2: Percentage of adults with any PUFA symptom by age, gender, ethnicity and East London
Variables
Percentage
Odds Ratio (95% CI)
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
5.93
10.33
15.88
1
1.82 (0.68, 4.94)
2.99 (0.55, 16.20)
0.23
0.20
303
168
34
505
Gender
Male
Female
Total
7.62
9.12
1
1.22 (0.45, 3.27)
0.69
282
223
505
Ethnic group*
White
Asian
Black
Total
9.08
1.65
8.33
1
0.21 (0.04, 1.13)
1.11 (0.45, 2.75)
0.07
0.82
283
72
126
481
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
10.29
9.25
5.03
1
0.83 (0.21, 3.26)
0.43 (0.09, 2.01)
0.78
0.28
178
153
174
505
All Adults
8.39
49
5.5.2: Current Pain
This survey assessed whether older adults were currently experiencing pain in their
mouth. Overall, ten percent of adults indicated that they were currently experiencing
pain in their mouths. Fewer older adults aged 65-74 years (9.0%) reported pain than
older adults aged 85 years and over (31.2%) (Table 5.5.2.1). There were no differences
between the percentage of male (9.0%) and female (10.2%) older adults currently
experiencing pain. There were also no ethnic or borough differences (Table 5.5.2.1).
50
Table 5.5.2.1: Percentage of adults reporting current pain by age, gender, ethnicity and East London and
Variables
Percentage
Odds Ratio (95% CI)
p value
Base
Age (years)
65-74
75-84
85 and over
9.03
5.51
31.19
1
0.59 (0.22, 1.59)
4.56 (1.63, 12.78
0.29
0.005
Total
Gender
Male
Female
509
9.22
10.76
1
1,19 (0.59, 2.41)
0.63
Total
Ethnic group*
White
Asian
Black
10.38
2.89
14.59
1
0.32 (0.08, 1.24)
1.78 (0.74, 4.28)
0.10
0.19
279
73
131
483
8.46
13.71
4.00
Total
All Adults
262
247
509
Total
ELC borough*
City and Hackney
Tower Hamlets
Newham
301
169
39
1
1.39 (0.58, 3.36)
0.35 (0.09, 1.37)
0.46
0.13
177
161
171
509
49 (10.05)
* Odds Ratios adjusted for age and gender
51
5.6: Patient-Reported Oral Health Impacts and Perceived Treatment
Need
5.6.1: Oral Health -Related Quality of Life
The survey used the Oral Health Impact Profile (OHIP-14) questionnaire to assess the
impact of oral conditions on daily life activities in the past 12 months (24). Total OHIP14 scores ranged from zero to 56 with higher scores indicating more severe oral health
impacts. We adopted the commonly accepted threshold level for assessing the
prevalence of oral health impacts for adults experiencing one or more problems
occasionally or more often in the previous 12 months (31).
The most commonly experienced problems were having an “aching” mouth (30.2%),
uncomfortable eating (29.6%), feeling self-conscious (19%), interrupted meals (18.0%),
feeling tense (15.0%), being embarrassed (13.6%) and having difficulty pronouncing
words (13.4%) (Table 5.6.1.1). Thirteen percent of older adults had eaten an
unsatisfactory diet because of problems with their teeth or mouth and 12.3% of older
adults reported problems with relaxing because of dental problems (Table 5.6.1.1).
Older adults in ELC reported a mean OHIP score of 6.15. Older adults aged 85 years and
over (mean OHIP-14=10.5), Asian older adults (mean OHIP-14=7.82) and older adults
living in Tower Hamlets (mean OHIP-14=6.84) reported significantly higher OHIP scores
than older adults aged 65-74 years (mean OHIP-14=6.04), White older adults (mean
OHIP-14=5.82) and older adults living in City and Hackney (mean OHIP-14=4.83) (Table
5.6.1.2).
More than half of all older adults (53.0%) experienced one or more of the problems
included in the OHIP-14 occasionally or more often in the previous 12 months (Table
5.6.1.3). There were no significant age, gender ethnic or borough differences related to
the percentage of older adults who reported one or more problems occasionally or more
often in the previous 12 months (Table 5.6.1.3).
52
Table 5.6.1.1: Number (%)of adults who reported problems related to oral conditions in the preceding
12 months in the sample of older adults living in East London and the City (ELC) in 2011
Number (%)
Percentage reporting the
problem occasionally/fairly
often/very often
Occasionally Fairly
Very
often
often
Functional limitations
Had trouble
pronouncing words
Felt their sense of taste
has worsened
58 (6.76)
24 (3.87)
15 (2.81)
13.44
60 (8.73)
25 (2.28)
7 (1.02)
12.03
165 (19.91)
51 (5.99)
32 (4.33)
30.23
129 (15.05)
60 (7.45)
43 (7.12)
29.64
Psychological discomfort
Have been selfconscious
Felt tense
71 (7.77)
48 (7.62)
22 (3.61)
18.99
69 (7.69)
28 (2.92)
23 (4.42)
15.03
Physical disability
Had an unsatisfactory
diet
Had to interrupt meals
54 (7.13)
25 (2.74)
18 (2.88)
12.75
98 (12.88)
28 (2.46)
19 (2.63)
17.96
55 (7.39)
18 (2.93)
12 (2.01)
12.33
46 (6.93)
20 (4.21)
14 (2.43)
13.57
41 (6.15)
8 (0.90)
8 (1.52)
8.56
31 (3.35)
6 (1.09)
1 (0.31)
4.74
49 (6.72)
28 (3.49)
9 (1.70)
11.88
15 (1.08)
10 (1.23)
1 (0.22)
2.54
Physical pain
Had a painful aching in
their mouth
Found it uncomfortable
to eat any food
Psychological disability
Found it difficult to
relax
Have been a bit
embarrassed
Social disability
Have been irritable with
other people
Had difficulty doing
usual jobs
Handicap
Felt that life in general
was less satisfied
Have been totally
unable to function
At least one problem
414 (52.97)
53
Table 5.6.1.2: Mean impact on quality of life (OHIP) score by age, gender, ethnicity and East London and
Variables
Mean
Prevalence Rate Ratio p value
Base
Age (years)
65-74
75-84
85 and over
Total
6.04
5.05
10.43
1
0.84 (0.65, 1.08)
1.72 (1.08, 2.73)
0.16
0.02
455
251
62
768
Gender
Male
Female
Total
5.23
6.87
1
1.31 (0.99, 1.74)
0.06
374
394
768
Ethnic group*
White
Asian
Black
Total
5.82
7.82
6.80
1
1.37 (1.05, 1.78)
1.18 (0.89, 1.56)
0.02
0.24
387
128
187
733
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
4.83
6.84
5.95
1
1.44 (1.03, 2.02)
1.25 (0.87, 1.81)
0.04
0.22
269
237
262
768
All Adults
6.15
Table 5.6.1.3: Percentage of adults who reported at least one impact (OHIP-14) in the past 12 months by
age, gender, ethnicity and East London and the City (ELC) borough in the sample of older adults living in
ELC in 2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
#
53.47
48.20
66.59
1
0.90 (0.74, 1.09)
1.25 (0.97, 1.58)
0.29
0.07
455
251
62
768
Gender
Male
Female
Total
51.47
54.15
1
1.05(0.88, 1.26)
0.58
374
394
768
Ethnic group*
White
Asian
Black
Total
51.23
60.15
59.44
1
1.20 (0.96, 1.50)
1.19 (0.98, 1.44)
0.10
0.09
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
45.51
55.23
55.16
1
1.19 (0.92, 1.54)
1.18 (0.93, 1.51)
0.19
0.17
All Adults
52.97
401
131
201
269
237
262
768
Prevalence rate ratios adjusted for age and gender
54
5.6.2: Perceived Need for Treatment
The survey questionnaire asked older adults whether they felt they would need
treatment if they visited the dentist tomorrow to capture older adults self-perceived
unmet treatment needs. The questionnaire also included a specific question about
participants’ perceptions about the need for a denture to assess the demands for
prosthetic dental care among older adults in ELC.
Nearly half of the older adults in the survey (49.2%) expressed a definitive need for
dental treatment (Table 5.6.2.1). There were clear differences between ethnic groups
and between older adults living in City and Hackney, Newham and Tower Hamlets. Black
older adults (60.6%) were more likely to report an unmet dental treatment need than
White older adults (48.3%) (Table 5.6.2.2). While 32.7% of older adults living in
Newham felt that they had an immediate dental treatment need, 58.5% of older adults
living in City and Hackney reported a perceived need for dental treatment (Table
5.6.2.2).
Fifty percent of older adults in ELC felt that they required a denture regardless of
whether they wore it (Table 5.6.2.3). Older adults aged 75-84 years and older adults
aged 85 years and over were more likely to perceive a need for a denture than older
adults aged 65-74 years (Table 5.6.2.3).
55
Table 5.6.2.1: Percentage of adults who perceived a need for treatment in the sample of older adults
living in East London and the City in 2011
Number (%)
Perceived Need for Treatment
371 (49.16)
No Perceived Need for Treatment
169 (26.06)
“Don’t know”/Not answered
217 (24.78)
All Adults
757 (100.00)
Table 5.6.2.2: Percentage of adults who perceived a definitive need* for treatment by age, gender,
ethnicity and East London and the City (ELC) borough in the sample of older adults living in ELC in 2011
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
45.51
51.89
58.49
1
1.14(0.92, 1.40)
1.28 (0.92, 1.78)
0.21
0.13
448
249
60
757
Gender
Male
Female
Total
48.01
50.07
1
1.04 (0.84, 1.30)
0.70
368
389
757
Ethnic group*
White
Asian
Black
Total
48.29
45.66
60.64
1
1.00 (0.72, 1.39)
1.32 (1.10, 1.58)
0.99
0.003
399
128
196
723
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
58.50
53.06
32.67
1
0.88 (0.72, 1.09)
0.55 (0.42, 0.73)
0.24
<0.001
259
233
265
757
All Adults
49.16
*Comparison group= No perceived need/don’t know
** Prevalence rate ratios adjusted for age and gender
56
Table 5.6.2.3: Percentage of adults who perceived a need for a denture by age, gender, ethnicity and East
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
41.98
57.55
70.03
1
1.37 (1.08, 1.75)
1.67 (1.29, 2.16)
0.01
<0.001
444
243
61
748
Gender
Male
Female
Total
46.16
53.92
1
1.17 (0.96, 1.42)
0.12
362
386
748
Ethnic group*
White
Asian
Black
Total
51.26
40.91
53.56
1
0.90 (0.64, 1.28),
1.17 (0.99, 1.38)
0.55
0.06
397
128
191
716
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
46.81
51.54
51.75
1.04 (0.81, 1.33)
1.09 (0.87, 1.36)
0.76
0.30
0.77
All Adults
50.53
257
232
259
748
* Prevalence rate ratios adjusted for age and gender
57
5.7: Oral Health Behaviours
5.7.1: Toothbrushing and Denture Cleaning
Survey participants answered questions about their tooth and denture cleaning habits
(oral hygiene). Sixty-five percent of older adults in ELC reported cleaning their teeth
twice a day or more often (Table 5.7.1.1). Among the older adults who reported wearing
dentures, 43.3% cleaned their denture twice a day or more often (Table 5.7.1.2).
Toothbrushing habits varied by age, gender, ethnicity and among older adults living in
different ELC borough. Older adults aged 85 years and over (59.2%) and male older
adults (45.2%) were more likely to brush their teeth less than twice a day compared to
older adults aged 65-74 years (30.3%) and female older adults (26%) (Table 5.7.1.3).
More than a third (38.7%) of White older adults cleaned their teeth less than twice day
compared to only 18.4% of Asian older adults and Black older adults (Table 5.7.1.3).
Older adults living in City and Hackney (37.2%) were more likely to brush less often
than older adults living in Newham (20.9%) (Table 5.7.1.3). Denture cleaning habits also
showed similar ethnic differences. White older adults (59.4%) were more likely to clean
their dentures less than twice a day than Asian older adults (47.5%) and Black older
adults (36.9%) (Table 5.7.1.4).
58
Table 5.7.1.1: Number (%) of adults who reported tooth cleaning frequency in the sample of older adults
Number (%)
Never
165 (27.48)
Less than once a day
21 (5.34)
Once a day
12 (2.04)
Twice a day
400 (55.39)
More than twice a day
72 (9.75)
All Adults
670 (100.00)
Table 5.7.1.2: Number (%) of adults who reported denture cleaning frequency in the sample of older
adults living in East London and the City (ELC) in 2011
Number (%)
Never
2 (1.20)
Less than once a day
9 (2.64)
Once a day
163 (52.85)
Twice a day
139 (40.38)
More than twice a day
17 (2.94)
All Adults
330 (100.00)
Table 5.7.1.3: Percentage of adults who cleaned their teeth less than twice a day by age, gender, ethnicity
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
30.34
36.14
59.23
1
1.19 (0.86, 1.65)
1.95 (1.38, 2.75)
0.29
<0.001
413
211
46
670
Gender
Male
Female
Total
45.20
26.02
1
0.58 (0.44, 0.75)
<0.001
338
332
670
Ethnic group*
White
Asian
Black
Total
38.70
18.38
18.42
1
0.47 (0.27, 0.83)
0.48 (0.35, 0.66)
0.009
<0.001
353
109
177
639
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
37.25
40.83
20.92
1
1.10 (0.81, 1.49)
0.56 (0.37, 0.86)
0.55
0.008
244
199
227
670
All Adults
34.87
* Prevalence rate ratios adjusted for age and gender
59
Table 5.7.1.4: Percentage of adults who cleaned their dentures less than twice a day by age, gender,
Variables
Percentage
Base
Age (years)
65-74
75-84
85 and over
Total
*
53.02
61.24
53.83
1
1.03 (0.89, 1.18)
1.05 (0.81, 1.36)
0.65
0.72
159
136
35
330
Gender
Male
Female
Total
67.66
49.86
1
0.90 (0.79, 1.02)
0.10
145
185
330
Ethnic group*
White
Asian
Black
Total
59.42
47.48
36.86
1
0.86 (0.70, 1.05)
0.82 (0.66, 1.01)
0.009
<0.001
109
100
81
315
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
46.29
62.37
52.91
1
1.13 (0.94, 1.37)
1.01 (0.85, 1.21)
0.19
0.87
104
107
119
330
All Adults
56.68
60
5.7.2: Sugar Consumption
Older adults in ELC answered questions about their sugar consumption related to eight
different food and drink items: chocolate, sweet biscuits or cookies, cakes, ice creams or
lollies, sweet yogurt, confectionary or other sweets, sweetened fruit juice and fizzy
drinks. Only 2.5% of older adults consumed more than four sugary intakes a day,
exceeding the World Health Organization’s daily sugar intake recommendation (Table
5.7.2.1).
61
Table 5.7.2.1: Number (%) of adults who reported daily sugary intakes in the sample of older adults
Variable
Number (%)
Zero to four sugary intakes/day
More than four sugary intakes/day
749 (97.50)
16 (2.50)
All Adults
765 (100.00)
62
5.7.3: Smoking and Betel Quid/Paan Use
The survey asked older adults about their current smoking and paan chewing habits.
Paan chewing is a custom commonly found in South East Asia, which involves chewing a
betel quid ─ a betel leaf containing areca nut, slaked lime and other spices with or
without tobacco. Betel quid is used as a breath-freshener, an antiseptic and stimulant; it
is also a known carcinogen (32).
Twelve percent of older adults in ELC were current smokers (Table 5.7.3.1). Even
though only four percent of older adults aged 85 years and over currently smoked
compared to 15% of older adults aged 65-74 years, this difference was not statistically
significant (Table 5.7.3.1). White older adults (11.9%) and Asian older adults (17.4%)
were more likely to be current smokers than Black older adults (4.9%). There was no
statistical difference between the percentage of male and female older adult smokers.
There were also no differences between the percentage of older adult smokers living in
City and Hackney (12.8%), Tower Hamlets (12.7%) and Newham (10.1%)(Table
5.7.3.1).
Four percent of older adults currently chewed paan or betel quid (Table 5.7.3.2). Sixtyone percent of older adult paan-chewers were Asian, 30% were White and nine percent
were Black.
.
63
Table 5.7.3.1: Percentage of adults who were current smokers by age, gender, ethnicity and East London
Variables
Percentage
Odds Ratio
p value
Base
Age (years)
65-74
75-84
85 and over
Total
15.12
9.69
4.33
1
0.60 (0.32, 1.15)
0.25 (0.06, 1.06)
0.12
0.06
457
251
61
769
Gender
Male
Female
Total
14.90
9.81
1
0.62 (0.37, 1.06)
0.08
376
393
769
Ethnic group*
White
Asian
Black
Total
11.90
17.40
4.89
1
1.26 (0.65, 2.41)
0.31 (0.14, 0.70)
0.49
0.005
401
133
201
735
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
12.78
12.73
10.08
1
1.10 (0.55, 2.21)
0.79 (0.37, 1.64)
0.78
0.52
272
237
260
769
All Adults
12.06
Odds ratios adjusted for age and gender
Table 5.7.3.2: Percentage of adults who chewed paan or betel nut in the sample of older adults living in
Variable
Number (%)
Paan/Betel Quid Chewers
35 (4.06)
No paan use
690 (95.94)
All Adults
725 (100.00)
64
5.8: Use of Dental Services
5.8.1: Dental Attendance Patterns
Older adults answered questions about their dental visiting behaviours specifically
related to the time since their last dental visit; the usual reason for visiting a dentist; and
whether or not they used NHS or private dental services.
Fifty seven percent of older adults had their last visit to the dentist within the past 12
months, 11.2% visited between one year and 24 months and 31.7% visited more than
two years ago (Table 5.8.1.1). There were no significant gender or borough differences
related to the time since their last dental visit but there were age and ethnic differences
(Table 5.8.1.1). Older adults aged 85 years and over (47.3%), older adults aged 75-84
years (36.3%) and Asian older adults (38.7%) and Blacks older adults (36.7%) were
more likely to have last visited the dentist more than two years than older adults aged
65-74 years (25.6%) and White older adults (30.3%) (Table 5.8.1.1).
Forty-six percent of older adults in ELC usually visited a dentist in response to a dental
problem rather than for regular or occasionally check-ups (Table 5.8.1.3). A higher
percentage of Asian older adults (67.8%) and Black older adults (58.6%) usually visited
the dentist in response to a dental problem than White older adults (43.9%) (Table
5.8.1.4).
The majority (83.2%) of older adults received NHS dental care services with 40.5% of
adults receiving free NHS dental care (Table 5.8.1.5). Thirteen percent of older adults
received exclusively private dental care (Table 5.8.1.5).
65
Table 5.8.1.1: Number (%) of adults reporting time since their last dental visit in the sample of older
Number (%)
Cumulative Percentage
(%)
Within in the last six months
270 (40.49)
40.49
In the last 7-12 months
126 (16.60)
57.09
More than 1 up to 2 years ago
108 (11.22)
68.31
More than 2 up to 3 years
56 (8.25)
76.56
65 (7.19)
83.75
50 (5.96)
89.71
More than 10 years
75 (10.29)
100.00
All Adults
750 (100.00)
Table 5.8.1.2: Percentage of adults whose last dental visit was more than two years ago by age, gender,
Variables
Percentage
Prevalence Rate Ratio
p value
Base
Age (years)
65-74
75-84
85 and over
Total
25.56
36.28
47.43
1
1.42 (1.00, 2.01)
1.85 (1.18, 2.90)
31.40
1
31.92
1.02 (0.72, 1.43)
0.92
Ethnic group*
White
Asian
Black
Total
30.30
38.69
36.66
1
1.47 (1.04, 2.06)
1.37 (1.03, 1.83)
0.03
0.03
395
129
192
716
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
27.69
31.18
36.28
1.06 (0.69, 1.64)
1.31 (0.87, 1.97)
0.78
0.20
260
235
255
750
All Adults
31.69
Gender
Male
Female
Total
#
0.05
0.007
447
243
60
750
367
383
750
Table 5.8.1.3: Percentage of adults reporting usual reason for a dental visit in the sample of older adults
Number (%)
Regular check-up
274 (41.18)
Occasional check-up
83 (10.01)
Only when having trouble with teeth/dentures
376 (46.44)
Never Been
16 (2.38)
All Adults
749 (100.00)
66
Table 5.8.1.4: Percentage of adults generally visit the dentist in response to a dental problem by age,
gender, ethnicity and East London and the City (ELC) borough in the sample of older adults living in ELC
in 2011
Variables
Percentage
p value
Base
Age (years)
65-74
75-84
85 and over
Total
42.24
50.13
55.55
1.13 (0.92, 1.39)
1.26 (0.94,1.67)
0.23
0.12
435
239
59
733
Gender
Male
Female
Total
51.67
44.23
1
0.86 (0.68, 1.08)
0.18
360
373
733
Ethnic group**
White
Asian
Black
Total
43.92
67.82
58.64
1
1.63 (1.29, 2.07)
1.41 (1.12, 1.77)
<0.001
0.004
387
125
189
701
ELC borough**
City and Hackney
Tower Hamlets
Newham
Total
45.61
45.20
53.80
1
0.97 (0.68, 1.38)
1.19 (0.88, 1.61)
0.87
0.26
253
225
255
733
All Adults
47.57*
* Excluding adults who had never visited the dentist
**Prevalence rate Ratios adjusted for age and gender
Table 5.8.1.5: Number (%) of adults reporting methods of dental payments in the sample of older adults
Number (%)
Private dental care
91 (12.93)
Paid NHS dental care
312 (41.96)
Free NHS dental care
319 (40.50)
NHS dental care with additional private care
5 (0.73)
Other
3 (0.44)
Unknown/not answered
20 (3.44)
All Adults
750 (100.00)
67
5.8.2: Relationship with Dental Practice
Older adults were asked about their previous contact with staff at the dental practice
they last attended to establish if they had an ongoing relationship with the dental
practice. This section includes information about participants’ perceived involvement in
their dental care decision making and patient-dentist factors related to trust, respect and
dignity. Older adults were also asked about any preventive advice that had received
from their dentist as recommended in the Department of Health Delivering Better Oral
Health: An evidence-based toolkit for prevention” related to smoking cessation,
toothbrushing, healthy eating and the appropriate use of dental services (33).
The vast majority (81.7%) of older adults had visited a previously attended dental
practice and would visit the same practice at their next visit (85.7%) (Table 5.8.2.1).
Most older adults reported good patient-dentist relationships. The majority (93.6%) felt
that the dentist had treated them with respect and dignity; most (89.1%) adults
expressed confidence and trust in their dentist (Table 5.8.2.2). Sixty-three percent of
older adults felt that their dentist have given them adequate time to discuss their oral
health and more than half (57.8%) felt that they had been involved in their dental care
making decisions (Table 5.8.2.2).
A smaller percentage of older adults reported receiving recommended preventive oral
health advice from their dentist (Table 5.8.2.3). Fifty-one percent of older adults recalled
advice given by their dentist about dental visits. Less than half (46.8%) had received
advice from their dentist about toothbrushing; 23.5% had received smoking cessation
advice and 16.6% had received dietary advice (Table 5.8.2.3). Fifty-three percent of
smokers had received smoking cessation advice.
68
Table 5.8.2.1: Number (%) of adults who previously attended a dental practice and who would visit the
same practice for their next visit in the sample of older adults living in East London and the City (ELC) in
2011
Number (%)
Previously visited dental practice
597 (81.71)
First time at dental practice
120 (18.29)
All adults
717 (100.00)
Intends to visit the same practice
Will not visit the same practice
599 (85.68)
89 (14.32)
All adults
688 (100.00)
Table 5.8.2.2: Number (%) of adults reporting patient-dentist relationship characteristics in the sample
of older adults living in East London and the City (ELC) in 2011
Number (%)
Base
Given enough time to discuss their oral health
Felt involved in their dental care decisions
Felt that the dentist treated them with respect and dignity
Had confidence and trust in their dentist
453 (63.91)
404 (57.87)
696 (93.57)
663 (89.12)
747
747
752
748
Table 5.8.2.3: Number (%) of adults who received advice from their dentist in the sample of older adults
Number (%)
Base
Advice given by dentists about tobacco cessation
Advice given by dentists/dental team about toothbrushing
Advice given by dentist/dental team about diet
Advice given by dentist/dental team about visiting the
dentist
195 (23.53)
324 (46.82)
132 (16.56)
352 (51.34)
747
748
753
750
69
5.8.3: Access to Dental Care Barriers
Older adults who had not attended the dentist in the past two years were asked about
the reasons for non-attendance to better understand the underlying factors behind not
adhering to the dental recall time-frame recommended by the National Institute for
Health and Clinical Excellence (NICE) (12). The most common response, given by 42.1%
of older adults who had not visited the dentist within the past two year was “no need to
see a dentist” because of their perception that nothing was wrong with their teeth (Table
5.8.3.1). Fifteen percent of older adults who had not attended gave other reasons
including poor health or health conditions, lack of need because of long-term complete
tooth loss, inability to contact a new dentist or other priorities. Thirteen percent of older
adults had not attended because of fear and six percent had not attended because of a
previous bad experience. Twelve percent of older adults had difficulties travelling to or
from the dental practice, which prevented them from attending the dentist. Three
percent of those who had not visited the dentist in the past two years could not afford
NHS dental charges and one percent had been unable to find a dentist (Table 5.8.3.1).
The survey also asked older adults whether they had tried to make an appointment
within the past three years to assess the impact of the new dental contract introduced in
2006. Sixty-two percent of older adults tried to make a NHS appointment in the past
three years (Table 5.8.3.2). The majority (94.8%) of older adults who tried to make an
appointment were successful and saw a dentist (Table 5.8.3.3). Older adults aged 85
years and over (45.7%) were less likely to have attempted to make a NHS appointment
in the previous three years than older adults aged 65-74 years (68.3%) (Table 5.8.3.4).
Thirty seven percent of older adults made an NHS appointment for routine check-ups,
33.6% made an appointment for non-urgent treatment and a quarter (25.3%) of older
adults made an emergency treatment appointment (Table 5.8.3.5).
Older adults were asked if they had ever delayed dental treatment because of cost to
ascertain whether cost was an important barrier to accessing dental care. Seventeen
percent of older adults had delayed dental treatment because of the cost while 80.3%
reported that cost had not delayed dental treatment seeking (Table 5.8.3.6).
70
Table 5.8.3.1: Number (%) of adults reporting the reason for not visiting the dentist in the past two
years among older adults who had not visited in the past two years in the sample of older adults living in
Number (%)
Base
No need to see the dentist/nothing wrong with my teeth
Other reason
I am afraid of dentists/ I don’t like seeing dentists
It’s difficult to get to and from the dentist
Not answered
I’ve had a bad experience with a dentist
I can’t afford the NHS charges
I haven’t got the time to see a dentist
Keep forgetting/I haven’t got round to it
Dentist changed to private/refused to do NHS work
I can’t find a NHS dentist
115 (42.10)
30 (14.63)
22 (13.48)
21 (12.30)
25 (8.08)
15 (6.63)
12 (3.19)
8 (2.62)
6 (2.44)
5 (1.62)
3 (1.15)
245
244
244
244
244
244
244
245
244
244
244
Table 5.8.3.2: Number (%) of adults who tried to make an NHS dental appointment in the last three
years in the sample of older adults living in East London and the City (ELC) in 2011
Number (%)
Tried to make an NHS appointment
460 (61.85)
Did not try to make an NHS appointment
261 (35.35)
Never tried to make an NHS appointment
13 (1.80)
All adults
734 (100.00)
Table 5.8.3.3: Number (%) of adults who tried to make an NHS dental appointment in the last three
years and who were successful and unsuccessful in the sample of older adults living in East London and
the City (ELC) in 2011
Number (%)
Tried and saw a NHS dentist
426 (94.84)
Tried but did not keep the appointment
5 (0.91)
Tried but could not make an NHS dental appointment
14 (2.32)
Not answered
10 (1.92)
All adults*
*Total refers to adults who tried to make an NHS appointment
455 (100.00)
71
Table 5.8.3.4: Percentage of adults who tried to make an NHS dental appointment in the last three years
by age, gender and ethnicity in the sample of older adults living in East London and the City (ELC) in
2011
Variables
Percentage
p Value
Base
Age (years)
65-74
75-84
85 and over
Total
68.30
56.96
45.69
1
0.83 (0.67, 1.04)
0.67 (0.46, 0.97)
0.10
0.03
434
241
59
734
Gender
Male
Female
Total
63.39
60.64
1
0.96 (0.79, 1.16)
0.65
360
374
734
Ethnic group*
White
Asian
Black
Total
60.58
70.19
63.36
1
1.09 (0.89, 1.33)
0.99 (0.85, 1.15)
0.40
0.85
387
129
186
702
ELC borough*
City and Hackney
Tower Hamlets
Newham
Total
51.68
64.18
65.99
1
1.29 (0.99, 1.68)
1.29 (0.99, 1.68)
0.06
0.06
258
226
250
734
All Adults
61.85
*Prevalence rate ratios adjusted for age and gender
Table 5.8.3.5: Number (%) of adults who reported the reason for making the NHS dental appointment
among those who attempted to in the sample of older adults living in East London and the City (ELC) in
2011
Number (%)
Routine check-up
Emergency or urgent treatment
Other non-urgent treatment
Other reason
Can’t remember/Not answered
194 (37.12)
145 (25.25)
138 (33.61)
6 (2.48)
12 (1.55)
All adults
495 (100.00)
*Total refers to adults who tried to make an NHS appointment
Table 5.8.3.6: Number (%) of adults who delayed dental treatment because of cost in the sample of older
Number (%)
Delayed care
No deferred care
Not answered
120 (17.15)
604 (80.34)
26 (2.52)
All adults
750 (100.00)
72
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Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman
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74
75
-
INVITATION LETTER – Adults older than 65 years
RE: A study of the oral health status and dental service use of older adults in City &
Hackney, Tower Hamlets and Newham
Dear Sir/ Madam
Your address has been randomly sampled to be included in a survey commissioned by
NHS East London & The City to assess the dental health needs of the local community.
NHS East London & The City and The Institute of Dentistry, Barts & The London School of
Medicine & Dentistry, Queen Mary University of London (QMUL), are about to carry out a
survey of local residents to understand their dental health needs. The outcome of the
survey will enable the Primary Care Trust to ensure they provide appropriate levels of
dental care in the future.
If you agree to take part, you will be offered an appointment in your own home or at a
local borough venue at a time to suit you. Also, please let us know if you have any
preference to be examined by a male or female dentist. There will be a simple oral
examination and a short interview to collect information on such things as when you last
visited to the dentist for the last time, and what your experience was at that visit.
If you are found to be in need of dental treatment, we will arrange for you to attend an
appropriate general dental practitioner, if you wish us to do so.
Please read the attached information sheet carefully before you decide to take part; this
will tell you why the research is being done and what you will be asked to do if you take
part. Please ask me if there is anything that is not clear or if you would like more
information. If you have any questions about this survey please contact Professor Wagner
Marcenes (QMUL) on 020 7882 8633.
Please complete the attached slip and return it in the prepaid envelope provided to
confirm your interest in participating in the study.
Yours sincerely
Wagner Marcenes
Professor of Oral Epidemiology
76
Oral Health in East London and the City
Name(s) of adults aged 65 years or more living in this address:
Name
Age
Name
1
3
2
Age
4
Contact telephone numbers if you prefer to be contacted by phone:
Home: ________________
Mobile: _________________ Work: ________________
Please tick to indicate availability and enter the choice of venue
Day
Morning
Afternoon
8:00-12 noon
12 noon14:00
Evening
14:0018:00
After 18:00
Choice of Venue
Please indicate Home
or borough
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please tick to indicate you want to be clinically examined by a female dentist
I want to be clinically examined by a female Dentist
Please tick to indicate you do not want to be clinically examined
I do not want to be clinically examined
Your address: ___________________________________________________
_______________________________________________________________
Postcode: ________________________
Signed by Patient: __________________________________ Dated: _____________
Please return this form to Institute of Dentistry in the self-addressed and prepaid envelope provided.
Thank you
77
Oral Health Survey of Older Adults in East London and the City
Participant information leaflet
Many thanks for taking time to read this leaflet about participating in the Older Adult Oral Health Survey.
The Inner Northeast London borough of NHS Tower Hamlets, NHS City & Hackney and NHS Newham are
currently recruiting participants to help us by taking part in this survey. This leaflet will answer any
questions you may have and help you in deciding whether to take part.
What is the survey about?
This survey will investigate older people’s dental health and their experiences of dental care, including
access to dental services. The survey consists of two parts: an interview, and a short, painless, dental
examination. The survey was granted ethical approval from East London Research Ethics Committee 3 (REC
Ref 11/LO/0027)
Who is conducting the survey?
This survey has been commissioned by Inner Northeast London Primary Care Trusts and examinations will
be conducted by the Community Dental Services.
Who can take part?
We are looking for adults aged 65 years or older who are living independently.
What happens if I take part?
If you decide to take part, an appointment will be made for two members of our team to meet with you. You
will be offered an appointment in your own home or at a local borough venue at a time to suit you. The
survey involves a short interview about your views on oral health and dental services followed by a short
simple examination of your mouth.
How long will it take?
The interview lasts about 20 minutes and the examination is about 10 minutes. The whole process should
last no longer than 30- 40 minutes from start to finish.
Why is the survey important?
Information about the oral health of the local population helps in planning and delivery of dental services
which will best meet the needs of the local community.
What will the information collected be used for?
Information collected will be used to help the NHS plan local dental services for older people. The borough in
Inner Northeast London will produce a report once the survey is completed. A summary of the main findings
will be made publicly available later in 2012.
78
Is the survey confidential?
Yes, the information you give us will be treated as strictly confidential as directed by the Code of Practice
adopted by the NHS. No identifiable information will be recorded on the survey forms – just a number – so it
will be anonymous on the paper sheets and when it is entered into the computer. The information will be
used to produce statistics that will not identify any individuals. Survey information is also provided to other
approved organisations for statistical purposes only. All such statistics produced are subject to similar codes
and the same standards of protection are applied to your information at all times.
Why was I chosen to take part?
As it is not possible to ask everyone to take part in the survey, a sample of residents is selected to represent
the borough you live in. You were selected at random from a list of residents for the survey.
Do I have to take part in the survey?
No you do not have to take part. Participation in the interview and examination is voluntary, although the
success of the survey depends on the goodwill and co-operation of those invited to take part. You may
withdraw from the survey at any time up the point where data is analysed, without any detrimental effect to
you. You do not have to provide any reason for not taking part in or withdrawing from the survey.
Are there any benefits to taking part?
Although there are no direct benefits to your participation, we hope that you find it rewarding to participate
in our study. Although the examination is not as thorough as attending your dentist you can ask for feedback
from the examiner about your teeth.
What if I need to know more or there is a problem?
If you have any questions or concerns about the survey you should ask to speak to our examination team
who will do their best to answer your questions (see contact information below).
For further information contact
Professor Wagner Marcenes
Institute of Dentistry, Barts and the London School of
Medicine and Dentistry, Queen Mary, University of London
4 Newark Street, London, UK
E1 2AT
79
Older Adult Oral Health Survey Examination Criteria, Version V.3 April 2011
Introduction
These criteria are for the use of the dental examiner during training and for reference purposes
during the fieldwork for the dental survey.
The criteria used are designed to be comparable with the Adult Dental Health surveys in the UK, in
particular closely matching the criteria for the 2009 survey.
Data for this survey will be recorded on paper record charts. Data will be entered onto the
appropriate grids by the interviewer who will be recording the data from examinations in the
fieldwork. All data will be transferred to a computer database for statistical analysis.
The criteria in this document should be studied in conjunction with the slides provided from the
training classroom session.
Medical Screening
Recent guidance from the National Institute for Clinical Excellence (NICE) now clearly states from
a review of best evidence that a dental examination, including periodontal probing, does not pose
a risk to patients with a previous history of Rheumatic Fever or other cardiac disorders. Specific
questions are no longer required to identify these patients. If subjects raise the issue of not
probing because of pre-existing medical conditions the following statement may be helpful “In the
past our policy was not to examine the gums of some patients as this was the part of the
examination where there was a possible risk. The National Institute for Clinical Excellence has
recently reviewed the evidence in this area and concluded that there is no significant risk from the
examination of teeth and gums, our policy is in line with this, BUT if you prefer us not to do the
gum examination please let us know”
Equipment set-up and seating the participant
The participant should be seated in a comfortable chair which has good head support, and to
which the examiner can get access. Individual examiner’s preferences vary. Kitchens are
sometimes difficult as the seats often have no head support. A comfortable chair in the sitting
room is usually fine, but access and lighting can be a problem. Consideration needs to be given to
the positioning of the “Daray” lamp, the availability of power points, and the convenience to the
participants. The lamp can be clamped to an ironing board if necessary.
The instruments should be laid out on a clean tissue out of sight of the participant if possible, but
allowing easy access. The light should be set up and adjusted. The Daray lamp should be set at the
high power setting (II) and dark protective glasses placed on the subject. To ensure good lighting
please use a new bulb at the start of the survey.
80
Cross Infection Control
Each examiner will carry sufficient sets of sterile instruments to ensure that there are sterile
instruments for every examination. Following the examination these will be placed in a sealed
container for transport back to the examiners home clinic where the instruments will be
autoclaved. Examiners will wear a clean pair of latex free gloves for the examination of each
participant. These will be disposed of into a standard yellow bag with any tissues and wipes after
the exam. This will be disposed of on return to the clinic along with normal clinical waste.
Diagnostic Criteria
The examiner should look briefly in the mouth to assess the overall distribution of natural teeth
and dentures. This may serve to put the participant at their ease before removing their prostheses
if they have them. It is essential that any dentures are then removed for the rest of the
examination. There are boxes on the form to record the presence or absence of dentures and their
condition.
The convention throughout the examination is:
If in doubt-score low
Existence of natural teeth, fixed replacements and debris score
Procedure
Using mirror and CPI probe the permanent teeth will be examined in the following order:
Upper right, upper left, lower left, lower right (i.e. clockwise as you look at the subject from in
front).
The interviewer will record the teeth as called, and may prompt you with the tooth number. It is
useful to establish good communication with the interviewer to ensure that recording errors are
kept to a minimum.
Prior to recording the code for the tooth, the examiner should call a code to indicate whether or
not there is any plaque (or supragingival calculus) on any surface of the tooth. The code is either
“P” where there is plaque or “C” (clean) where there is not.
Having called out the debris code for the tooth, and cleaned the surfaces of gross debris (if
necessary); the surfaces of the tooth should then be examined one at a time.
Record which teeth are present using the following codes:
P = Natural tooth present with VISIBLE plaque (to naked eye, without running probe around)
C = Natural tooth present and Clean, no plaque visible to the naked eye
M = Tooth missing
F = Tooth replaced by bridge pontic, implant pontic or implant
81
State of coronal surfaces
The next stage of the examination is to record the condition of the crowns of the natural teeth.
If in doubt - score low (i.e. “least disease”).
Procedure
Using mirror and CPI probe the permanent teeth will be examined in the following order:
Upper right, upper left, lower left, lower right (i.e. clockwise as you look at the subject from in
front).
Clean the surfaces of gross debris (if necessary), and dry the teeth with cotton wool rolls prior to
this stage of the examination. The surfaces should then be examined one at a time, and the code
for each tooth called out clearly. Clarity of calling is of the first importance if the examination is to
be completed efficiently and accurately.
The code for this stage should be entered into the record chart.
The codes available match with those used in the Adult Dental Survey. As usual where two or
more conditions exist on one tooth the caries code takes priority. This is to ensure that new
dentine caries is never left unrecorded. Similarly if there is a filling which is fractured and carious,
the filled and carious code (4) is the one recorded not code R, so that recurrent dentine caries is
always recorded.
The following codes indicate the presence of a restoration or sealant. All of the codes below must
always be qualified by a second code which indicates the condition of the restoration or sealant.
F = Intracoronal restoration
This will usually be amalgam, composite or glass ionomer, but also includes inlays or onlays and
the
restored surfaces of ¾ crowns.
V = Veneers, shims, retentive wing of adhesive bridges, repair of fractures or wear
These are adhesive restorations. They are used simply to change the shape of a tooth or as
adhesive retainers for resin bonded bridges. A shim is a thin metal restoration cemented onto a
functional surface (such as the palatal surface of an upper anterior or a molar occlusal surface) to
change its shape. These are rare. A veneer is usually placed buccally to improve colour or shape,
these are fairly common. The difference between them is not important, but neither is placed to
treat caries. The key difference between code V and code R is that the restorations for code R are
placed following restoration, usually for caries treatment, whilst those for V are stuck on to the
surface to fulfil an aesthetic or occlusal need. Restorations placed on incisal edges of anterior teeth
to repair fractures should also be coded V, assuming that there is no question of them being placed
to treat caries.
K= Full crown
This may be either permanent or temporary, and including full coverage bridge abutments for
conventional bridges. It does not include ¾ crowns, these are coded ‘R’ on the relevant surface.
82
Temporary crowns are coded Y.
X = Sealants
All sealants should be recorded whether they are full or partial and each should be qualified by a
second code just like all of the other restoration codes, e.g. a partial sealant would be coded XY. It
is often impossible to be sure whether or not a sealant is a sealant alone or whether there is a
restoration underneath. Where there is clear evidence of a sealant restoration (but only where
there is clear evidence) this should be coded as F instead.
Classification for Dental Caries (and failed restorations) (Coronal)
0 = Sound
Code 0 (Zero) is used for all surfaces that are present and have no clinically discernible caries
experience under the conditions of the examination. A surface is recorded as “sound” if it shows no
evidence of treated or untreated dental caries. In the case of partly-erupted teeth, where some
surfaces may not be visible; these will be considered as sound and recorded under this category.
Partially erupted teeth with no signs of caries or restoration should be coded as sound on all
surfaces. Surfaces with hypoplasia, fluorosis and other developmental defects are recorded as
sound unless they are also affected by caries.
Y = Failed restoration of any kind, but not carious
This may be a restoration which is chipped cracked or which has a margin into which a ball-ended
probe tip will fit. Temporary crowns are included here.
H = Hard, arrested decay The surface should show exposed dentine which is glossy and hard,
despite being discoloured. There has been decay but it is now arrested. Be careful to distinguish
this from extrinsic staining and also note that there must be dentine exposure.
4 = Visual dentine caries (underlying dentine shadow - non cavitated dentine caries)
The surface has decay present into dentine which is visible to the observer, but which is NOT
obviously cavitated - such lesions may exhibit signs of localised enamel breakdown but no
cavitation into dentine. These lesions will usually manifest as shadowing under an occlusal surface
or marginal ridge.
5 = Distinct cavity with visible dentine
The surface has decay present into dentine which has caused the lesion to cavitate exposing
dentine. Record ‘5’ only if there is a cavity (but not “6”, see below In line with previous surveys,
this also includes temporary dressings placed for the treatment of caries.
6 = Extensive cavity with visible dentine
Code 6 is used for obvious loss of tooth structure, the cavity is both deep and wide and dentine is
clearly visible on the walls and at the base. An extensive cavity involves at least half of a tooth
surface or possibly reaching the pulp. This code is used for teeth which are so broken down that it
is inconceivable that there is not pulp involvement and where restoration of the tooth would be
very involved or impossible. This code includes carious stumps or teeth so broken down that
whole surfaces have been eliminated through caries. It should not be used for little bits of retained
root left after extraction (which should be ignored at this stage), or for overdenture abutments
(code 9). There must be presumed active soft carious dentine.
9 =Not possible to code
Code 9 is used throughout the examination for occasions where you cannot make a reasonable
judgement. It should be used VERY sparingly. In the case of coronal surfaces it represents
circumstances where an entire surface is actually missing because it has fractured off or worn
away, such that there is nothing that you can code. This is rare; if there is anything there you
should score it. The most likely use for code 9 is for overdenture abutments. If a surface is missing
83
because it has broken down through caries then 5 or 6 should be used. Code 9 is used only for
surfaces where more than half of the surface is covered, where less than half of a surface is
obscured it should be coded according to what is seen.
For this part of the examination the CPI type C probe should only be used for the following:
•
removing debris from around key areas if necessary.
•
placing into open crown margins or defects at the margin of restorations to estimate their
dimension, but this should not be done with force.
It should not be used for probing into fissures or early lesions.
Priority
Data are collected on a tooth by tooth basis, so the possibilities of having more than one code on a
tooth exist. On occasion there may be a restoration and completely unrelated caries. In these
situations the dentine caries code will ALWAYS take precedence, so if for example codes 4 and R
are encountered, then code4 should be entered. This is to ensure that new dentine caries is never
left unrecorded. Similarly if there is a filling which is fractured and carious, the dentine caries code
(4, 5, 6) is the one recorded as the code, not code Y, so that recurrent dentine caries is always
recorded unless there is new caries on the same surface. If a restoration has been lost entirely the
code used to record this must fall into a restoration code – i.e. within the “F” component of DMFT.
In summary when different codes are encountered on the one tooth, the order of priority that is
called is:
(M/A/B/T)>6>5>4>H>F>V>K>X>Y>9>0
Summary - coronal surfaces
•
move clockwise around the mouth
•
The presence or absence of any plaque is called out first along with missing and teeth
replaced by fixed methods – prior to cleaning
•
All surfaces will be examined but a single code for each tooth given
•
where there is a restoration it must be assumed that fillings have been provided for the
treatment of caries, the reasons for providing crowns cannot be known
•
On occasions where there is both new decay and a separate restoration on the same tooth,
caries will always take priority.
84
Root Surface Conditions
Procedure
Having completed the coronal surfaces the examiner should return to examine any exposed root
surfaces in the same order as was used for those surfaces. It is important that you keep the
recorder orientated. You should call out which teeth you are on as you progress or at the very
minimum you should indicate when the midline is reached. On no account should you try to do the
roots at the same time as the crowns.
Diagnosis of root caries is different from that for coronal caries, and requires the use of a
sharpened probe, because textural changes are at the heart of diagnosis. The examiner will now
need to pick up the root probe. Note that this instrument is used for no other surface. The probe
should be used on the surface of the roots to determine texture or detect cavitated defects. Do not
try to push the tip hard into dentine. You will get some indication of the texture by dragging it
across the surface, and gently feeling for any softness. Do this if there is any question of decay.
Anything exposed apical to the cemento-enamel junction (or when the CEJ has been replaced by a
restoration, the apical margin of the restoration) is regarded as root surface. All four surfaces must
be examined, to ensure complete coverage of the root surface.
Codes and criteria
Each root surface of every tooth should be examined and a single code for each tooth called for
primary caries and 2 codes for restored root surfaces using the codes below.
Remember, if in doubt, score low (i.e. least disease)
The codes below are restoration codes and must always be used with a second code using exactly
the same convention as for coronal surfaces. One of the codes 0, 4, 6, H or Y must be used to
describe the condition of the root restorations.
F = Filling or restoration (see note below)
N = No exposed root surface
0 = Exposed root surface present but no evidence of current or past disease
Exposed root surface is any exposure of the root coronal to the gingival margin
W = Worn to a depth of 2mm or more, but with no caries or restoration
Y= Failed restoration of any kind, but not carious. This may be a restoration which is chipped,
cracked or which has a margin into which a ball- ended probe tip will fit.
H = Hard, arrested decay
The surface should be glossy and hard, despite being discoloured. There has been decay, but it is
now arrested. .
4 = Caries on the root surface equivalent to coronal caries codes 4 or 5
This is any caries which is believed to be active on the basis of texture. An active root lesion can be
almost any colour from yellow or tan through to almost black. In some circumstances it can even
be very difficult to tell caries from extrinsic staining. The texture is very important and the probe
must be used to try to determine this. Anything which shows evidence of softening or frank
cavitation should be coded as carious. Shiny dark areas are much less likely to be actively carious
85
and more likely to be arrested, such areas should be coded as “H. Usually stained calculus and
extrinsic staining will be fairly obvious, but if there is any doubt the texture is critical.
6 = Extensive cavity
These lesions are deep and wide and probably involve the pulp. Code 6 is also used when there has
been gross destruction of the tooth and there are only roots remaining.
9 = Unscorable
Code 9 should be used sparingly, and only if it is not clear whether or not there is any root
exposure. This is most likely where there are very large deposits of calculus around lower incisors.
If there is any visible root it should be coded with the appropriate letter. If there is no root surface
exposed then a code 0 should be used. Only if the examiner suspects an exposed root surface, but
cannot examine it should a code 9 be entered.
Note:
Most restorations are either clearly crown or root restorations. But some restorations and lesions
straddle the CEJ and these are difficult to call. Here the 3mm rule will apply. This goes as follows:
If the restoration is clearly a coronal restoration which encroaches on to the root, it should ONLY
be coded as a root restoration as well as a coronal restoration if it extends 3mm or more beyond
the CEJ (or the estimated CEJ) and onto the root surface. The distal section of the CPI probe (above
the ball end) can be used to measure this if necessary.
If there is frank caries at the margin of the filling extending from the coronal onto the root surface
then this will count as caries on the root, even where the restoration does not extend 3mm. In this
case the condition of the coronal portion of the filling will be coded independently according to the
condition of this part of the tooth.
If a root restoration extends onto the crown, the same 3mm rule applies in reverse (i.e. there must
be 3mm beyond the CEJ on to the crown to count as a coronal restoration), but any caries
occurring on the coronal portion of a root restoration is recorded as coronal caries, whilst the root
restoration is scored according to its condition.
Some lesions and some fillings are smaller, they straddle the CEJ and it is difficult to be sure
whether they are primarily on the root or the crown and do not extend 3mm onto either. In this
case they should be recorded as root as this is the more vulnerable surface if it is exposed.
Artificial crowns cause a particular problem because it is often impossible to identify the CEJ.
Where there is a crown and the CEJ is covered, the margin of the crown should be considered the
same as the CEJ, unless the contour of the crown indicates where the CEJ lies in which case the
extension of the crown beyond this can be measured. On the rare occasion where this extends
3mm or more on to the root surface, the surface should be recorded as filled.
Summary - root surfaces

Root surfaces are examined in a separate single sweep of the mouth, examining the teeth in
the same order as for crowns

Use only a single code for the whole root surface; the codes are similar to those for crowns

You must use a sharp probe to assess texture
Priority in scoring for the roots is as below
86
6>4 >F>Y>H>W>9>0>N
Tooth Wear
Procedure
The assessment of tooth wear is a part-mouth examination. The teeth should be inspected in good
light, from the upper right canine to the upper left canine, and then left canine to right canine in
the lower arch, just as for the previous parts of the examination. Each tooth should be assessed
looking at each coronal surface (root surfaces have been recorded during the examination for
roots). In order to provide comparable data with other surveys, scores are recorded on three
surfaces per tooth for the six upper teeth, the buccal, incisal and palatal. For the lower teeth, the
worst surface score is the one recorded and this will almost always be the incisal score, but if
buccal or lingual surfaces are worse, then this is recorded. In many cases there will be very heavily
restored teeth or crowns, these cannot be scored, but are not missing and should be coded as
unscorable.
Remember the convention: If in doubt - score low.
Codes and criteria
Score Surface
Criteria
0
All
Sound, Any wear is restricted to the enamel and does not extend into dentine
1
All
Loss of enamel just exposing dentine
2
B,L
Loss of enamel exposing dentine for more than an estimated one third of the
individual surface area (B,L).
Incisal Loss of enamel and extensive loss of dentine, but not exposing secondary
dentine or pulp. On incisal surfaces this will mean exposed dentine facets with a bucco-lingual
dimension 2mm or greater at the widest point (see diagram)
3
B,L
Complete loss of enamel on a surface, pulp exposure, or exposure of secondary
dentine where the pulp used to be. Frank pulp exposure is most unlikely. Incisal
Pulp
exposure or exposure of secondary dentine
8
All
Fractured tooth - clear evidence of traumatic loss of tooth substance rather than
wear.
9
All
Unscorable. >75% of surface obscured (e.g. large occlusal cavity or restoration) or
no remaining incisal edge/tip which can be coded. If any incisal edge/tip is present and a score
may be given, this should be done. All crowns and bridge abutments are given this code.
Notes:
1.
Bridge pontics are coded as missing and will be blocked out.
2.
Code 2 is the most difficult one to judge. Use the CPI probe (shaded band) to measure the
diameter of any exposed dentine facet if necessary.
3.
Where wear is severe, it can often be contiguous from palatal onto incisal, such that it is
difficult to distinguish the surfaces. In these instances, code both the same.
4.
Frank pulpal exposure is very rare, but exposure of secondary dentine (where the pulp
used to be),usually appearing as a small translucent area in the centre of a wide area of dentine
exposure, is not uncommon in older people.
Summary - Tooth wear
only upper and lower anterior teeth are examined
upper surfaces and the worst lower surface of each of the teeth is recorded
many teeth may be unscorable because of restorations
87
Occlusion - functional occlusal contacts
The assessment of occlusal contacts refers to occlusal contacts between natural teeth and the
pontics of fixed bridges only. This short examination examines only the posterior (premolar and
molar) regions. The examination is conducted without dentures.
Procedure
A contact is the same as an occlusal stop. For the purposes of this examination you should get the
subject to close together normally on the back teeth (sometimes the phrase “clench your back
teeth together” is the most effective) and then using a mirror to hold back the cheek, look at the
lower arch from the side and record the distribution of contacts. In the posterior region we are
looking for tooth to tooth contact involving one or more lower pre-molars and then a contact
involving one or more lower molars. The presence of a contact is determined by the lower tooth.
Just look at each side in turn and work out whether or not there is a NATURAL contact between a
lower molar and another natural tooth, then between lower premolar and another natural tooth
(note for the purposes of this a bridge pontic or implant counts as a natural tooth – it is supported
by one – but a denture does not).
The scoring is quite easy obviously if there is NO lower tooth or bridge pontic in the area you are
looking at, there cannot possibly be a contact. Record contact between premolars (1 or 0), then
between molars on the right and repeat on the left.
Codes and criteria
Posterior functional contacts
0 = No posterior functional contact
88
1 = Posterior functional contact present
Notes:
A posterior functional contact is classified as present where the contact forms a vertical occlusal
stop. This is recorded according to the lower tooth (i.e. does the natural lower or bridge pontic
contact with any natural upper or pontic), and is coded as a “1” even if the area of contact is small.
In rare cases where there is contact but no occlusal stop (e.g. a scissors bite) a zero is recorded.
Clearly there can be no contact if there is no lower tooth in the zone you are looking at
In some cases it may be difficult to tell whether the teeth actually touch or not, you should assume
that they do if you are in doubt.
Anterior Spacing
The subject will have removed any dentures, but you may now need to look at them to help you
decide on the correct codes. This examination is much easier to carry out from in front of the
participant.
In this part of the examination you are looking for space in the anterior region, as far back as the
second premolar zone to give some indication of aesthetics and the need for dentures and bridges.
You are not recording which teeth are missing, that has been done already. For this reason it is
again much easier if you start at the midline and work backwards but examine the quadrants in
the same order as the rest of the exam (upper right, upper left, lower left and lower right). This
way it is much more straightforward to assess the position of spaces as you can use the midline as
a reference. As you look around you should look for spaces of half the width of the expected tooth
at each zone. If there is a space present then call it out, the code depends on whether or not it is
filled by an artificial tooth. If there is a natural tooth call it as “no space”. Note that because teeth
drift you may have a space at (for example) the upper second molar position even when that tooth
is present (it may have drifted to a different position). What is important is that there is a space at
that position, the teeth present are irrelevant. Your job is to map the spaces, you can completely
ignore the tooth type. (see diagram)
Codes and criteria: spaces
Record for each tooth position the following codes:
N = No space (tooth present or space closed)
T = Implant retained restoration replaces tooth, so no space.
S = Space equal to, or more than, ½ the size of the tooth you would normally expect to be in that
space
D = Space restored by a removable prosthesis
B = Space restored by a fixed bridge
89
Summary - spaces
once again, start in the midline and work out
record the position of any spaces as far back as the second premolar space
there are different codes for filled and unfilled spaces.
Dentures
You will now have to hand any dentures the participant may have. The dentures, including
full dentures opposed by natural teeth or partial dentures should be examined separately,
upper and lower, for the following features:
Presence or absence of any dentures; whether one or both are unequivocally in need of
repair
Denture type (recorded separately for upper and lower arches) Codes and criteria:
dentures
For each arch record:
0 – no denture present
1 – Partial denture present
2 – Full denture present
3 – Overdenture present
4 – Implant retained denture present
For each denture present record the material:
1 – Metal base denture
2 – Acrylic based denture
90
For each denture record the status:
0 – intact
1 – Needs repair
Summary - dentures
•
All dentures are examined
•
The examination is self explanatory
PUFA Index (Pulp, Ulceration, Fistula, Abscess)
Examiners will ask the patient the following question:
Do you have any problem or pain in your mouth at the moment?
If they respond “No” record 0 (zero) and move to the next step. If they respond “Yes”
enquire:
Do you think that there is pain related to your teeth?
If they respond “No” record 0 (zero) and move to the next step. If they respond “Yes” then
code as 1.
Problem or Pain codes
0 = No problem or pain
1 = Yes problem and/or pain
Examiners will then record the number of lesions present in the patient’s mouth for each
of 4 forms of sepsis. The mouth should be examined in the same order as before (upper
right, upper left, lower left, lower right), ensuring that the lips or cheeks are gently
retracted to allow the soft tissues to be examined. A single code (0, 1 or 2) will be called
for each of the four conditions examined. The descriptors for each condition are identical.
Description of conditions to be recorded in PUFA
P = open pulp in permanent dentition
U = obvious ulceration
F = fistula in permanent dentition
A= abscess in permanent dentition
Codes and criteria: PUFA
0 = No lesions evident
1 = A single lesion present
2 = 2 or more lesions present
91
Periodontal conditions
This assessment is not undertaken on implants. Please make sure that the probe you have
is the “type C” probe which has marks at 8.5mm and 11.5mm as well as at 3.5mm and
5.5mm.
There are four parts to this examination for patients, recording of pocket depths, loss of
attachment (LOA) calculus and bleeding. The worst score for each criterion will be
recorded by sextants. If there is a single tooth in a sextant the sextant will not be recorded
and the tooth will be considered to belong to the adjacent sextant.
Pocket depths and loss of attachment (LoA) will be probed at two sites (mesial and distal)
on each tooth; these two sites will be buccally on upper teeth and lingually on lower teeth.
The worst score in each sextant will be recorded. Gently insert the CPI probe into the
sulcus distally on the tooth and observe the pocket depth and, if appropriate, loss of
attachment at which resistance is felt. This manoeuvre should not cause pain or blanching
of the tissue, if it does, you are using too much pressure (as an indication of the force
required when probing, place the probe below your fingernail, this should not be painful if
the appropriate pressure is used). Reinsert the probe mesially on the tooth to obtain the
readings for that surface, measure the other teeth in the sextant in the same way. At each
surface you need to mentally note the pocket depth, you must also note the loss of
attachment scores. Having completed the measurements for the sextant call out the worst
score for pocketing, followed by the worst loss of attachment score then call out the single
calculus score, and bleeding score for the sextant. It may take 20-30 seconds after probing
for bleeding to be evident.
Start in the upper right and then work each sextant in sequence (distal then mesial). At
each tooth in each sextant mentally note the pocket score and call the worst score in each
sextant. Also record the worst LoA score for the sextant. Next record the calculus score for
each sextant. The presence of calculus is called if it is visible or if it can be detected with
the probe. Finally, record bleeding score. You will thus be calling 24 codes in subjects (4
per sextant).
Codes and criteria: pocket depth and loss of attachment
The codes are the same for the two measures.
0 = Up to 3.5mm (first probe band)
1 = 4-5.5 mm (dark band)
2 = 6-8.5 mm (first area above the dark band)
3 = 9+ mm (second area above the dark band)
9 = Unscorable
92
Notes:
1. Pocketing is recorded from the gingival crest to the base of the pocket.
2. Loss of attachment is recorded from the base of the pocket to the cemento-enamel
junction (CEJ). If this is damaged by a filling or restoration and there is no indication of
where it should be then you should use the margin of the restoration. In most cases you
can get an indication of where the CEJ should be, even where there are calculus deposits.
3. Code 9 should only be used if you cannot probe a pocket, either because of discomfort
or because there is a physical barrier (e.g. a large shelf of calculus). In a few cases it may
be necessary to use a code 9 where it is impossible to judge the position of the CEJ because
of calculus.
Codes and criteria: calculus
Each surface, buccal on upper teeth, lingual on lowers should be examined for the
presence of supra- or sub-gingival calculus, and a single code recorded for the sextant
following codes:
0 = No visible or detectable supra- or sub-gingival calculus
1 = Any supra- or sub-gingival calculus detectable with the probe or visible with the naked
eye.
9 = Unscorable.
Codes and criteria: bleeding
Each surface, buccal on upper teeth, lingual on lowers should be examined to determine if
there is bleeding from any of the pockets in the sextant, a single code is recorded for each
sextant:
0 = No visible bleeding
1 = Evidence of bleeding
Summary - periodontal examination
The order of the examination is the same as for crowns (i.e. clockwise)
There are 4 codes for each sextant, pocket, then attachment, then a score recording the
presence of any calculus and bleeding
The sites are mesial and distal, examining the buccal surfaces of upper teeth and the
lingual surfaces of lowers
Gingival tissues around implants are not probed
93
Older Adult Oral Health Survey East London and the City
Dental Examination
Prior to starting the examination:
Interviewer to ensure the consent form has been signed
Dentist to check whether respondent is happy to start, or whether they
want to clean their teeth before starting the examination.
Beginning of the examination:
Interviewer to ask dentist:
Does the respondent have natural teeth in both arches?
Yes/No
If no, does the respondent have natural teeth in upper arch only?
Yes/No
Or Natural teeth in lower arch only?
Yes/No
94
1. Tooth Condition
Tooth Condition
UPPER RIGHT 8
UPPER RIGHT 7
UPPER RIGHT 6
UPPER RIGHT 5
UPPER RIGHT 4
UPPER RIGHT 3
UPPER RIGHT 2
UPPER RIGHT 1
Debris
Code
Tooth Condition
LOWER LEFT 8
LOWER LEFT 7
LOWER LEFT 6
LOWER LEFT 5
LOWER LEFT 4
LOWER LEFT 3
LOWER LEFT 2
LOWER LEFT 1
Debris Code
Tooth Condition
UPPER LEFT 1
UPPER LEFT 2
UPPER LEFT 3
UPPER LEFT 4
UPPER LEFT 5
UPPER LEFT 6
UPPER LEFT 7
UPPER LEFT 8
Debris
Code
Tooth Condition
LOWER RIGHT 1
LOWER RIGHT 2
LOWER RIGHT 3
LOWER RIGHT 4
LOWER RIGHT 5
LOWER RIGHT 6
LOWER RIGHT 7
LOWER RIGHT 8
Debris
Code
2. Root Condition
Root Condition
UPPER RIGHT 8
UPPER RIGHT 7
UPPER RIGHT 6
UPPER RIGHT 5
UPPER RIGHT 4
UPPER RIGHT 3
UPPER RIGHT 2
UPPER RIGHT 1
Code
Root Condition
UPPER LEFT 1
UPPER LEFT 2
UPPER LEFT 3
UPPER LEFT 4
UPPER LEFT 5
UPPER LEFT 6
UPPER LEFT 7
UPPER LEFT 8
Root Condition
LOWER LEFT 8
LOWER LEFT 7
LOWER LEFT 6
LOWER LEFT 5
LOWER LEFT 4
LOWER LEFT 3
LOWER LEFT 2
LOWER LEFT 1
Code
Root Condition
LOWER RIGHT 1
LOWER RIGHT 2
LOWER RIGHT 3
LOWER RIGHT 4
LOWER RIGHT 5
LOWER RIGHT 6
LOWER RIGHT 7
LOWER RIGHT 8
Code
Code
95
2. Tooth Wear
Tooth Wear
UPPER RIGHT 3
UPPER RIGHT 2
UPPER RIGHT 1
UPPER LEFT 1
UPPER LEFT 2
UPPER LEFT 3
TWearB
Tooth Wear
LOWER LEFT 3
LOWER LEFT 2
LOWER LEFT 1
LOWER RIGHT 1
LOWER RIGHT 2
LOWER RIGHT 3
TWearI
TWearL
TWear
3. Occlusal Condition (contacts)
Posterior Functional Contact
RIGHT PRE- MOLARS
RIGHT MOLARS
LEFT PRE- MOLARS
LEFT MOLAR
Contact
4. Spaces
Spaces
UPPER RIGHT 1
UPPER RIGHT 2
UPPER RIGHT 3
UPPER RIGHT 4
UPPER RIGHT 5
Space
Spaces
LOWER LEFT 1
LOWER LEFT 2
LOWER LEFT 3
LOWER LEFT 4
LOWER LEFT 5
Space
Spaces
UPPER LEFT 1
UPPER LEFT 2
UPPER LEFT 3
UPPER LEFT 4
UPPER LEFT 5
Spaces
LOWER RIGHT 1
LOWER RIGHT 2
LOWER RIGHT 3
LOWER RIGHT 4
LOWER RIGHT 5
Space
Space
96
Respondent
Interviewer
Dentist
6. Dentures
Is there a denture present in the mouth?
Yes/No
If yes, is the denture upper, lower or both?
Upper/lower/both
What is the upper/lower denture type?
Partial/Full/Complete/Implant
What is the denture base material?
Metal/Plastic
What is the status of the upper/lower denture? Denture intact/ In need of repair
7. PUFA Index
Dentist to ask the respondent whether there is any pain present in the mouth at the
moment?
Yes/No
PUFA
Pulp
Ulceration
Fistula
Abscess
Lesion Present
8. Periodontal condition
Periodontal Condition
SEXTANT 1: upper R molars and
premolars
SEXTANT 2: upper R to upper L
canine
SEXTANT 3: upper L premolars and
molars
SEXTANT 4: lower L molars and
premolars
SEXTANT 5: lower L to Lower R
canine
SEXTANT 6: lower R premolars and
molars
Two Tee
Pocket
LoA
Calc
Bleed
End of the clinical examination
For Dentist to complete
Feedback letter issued:
Yes
/
No
Name of the advice letter given to the patient:
A
B
C
C2
D
E
E2
97
Medical screening check:
All questions below must be answered before proceeding with the examination.
1. Have you ever had Rheumatic fever or St Vitus Dance?
Yes
No
2. Do you have any artificial heart valves or a heart murmur?
Yes
No
3. Have you ever had any heart surgery/
Yes
No
4. Do you have any artificial joints, such as artificial hip or knee joints?
Yes
No
5. Have you ever hepatitis or jaundice/
Yes
No
Yes
No
6. Do you have or ever have had any medical condition which has caused you a
problem with dental treatment in the past?
Note: the responses to question 5 and 6 are to inform the examiner. A positive answer
should not usually prevent the examination from proceeding. This is entirely at the
discretion of the examiner.
98
Protocol for Participants with Suspected Serious Pathology
For the survey, in line with current ethical practice, feedback can be provided to each
person who takes part in the examination. The administrator is permitted to say, when
contacting potential participants, that the dentist may be able to offer them some advice on
the best way of looking after their mouth or teeth.
During the examination the examiner may encounter a lesion which may give concern of
potential serious pathology. It should be noted that dentists are highly unlikely to encounter
such serious pathology in this survey because:
• The incidence of such lesions is low
• The examination is not a screening exercise for such lesions
• The examination does not involve detailed examination of all the oral soft tissues
However in the event that such a lesion presents to an examiner, they must advise the
participant in a manner which will convey the examiners concerns yet not cause too much
distress to the individual.
If the participant does not have a GP or a GDP the examiner will offer for an appointment to
be made with a GP or GDP by the lead clinician and will be provided with letter D. If the
participant does not accept this offer they will be provided with letter E2
If the participant does have a GP or GDP an offer will be made for the lead clinician to
contact the GP to inform them of the suspicious lesion and for an appointment to be made
for a ‘check visit’. If the participant does not wish for the lead clinician to do this then they
will be provided with letter E1
The lead clinician of the fieldwork teams or the will take responsibility for taking
appropriate action on any report of serious pathology. All examiners must report the
participant details, nature of the suspected lesion, decision made by the participant and
which letter was provided to them to the lead clinician.
The named lead clinician for reporting serious pathology;
Dr Eunan O’Neill
Specialist Registrar Dental Public Health
NHS East London & The City
Public Health Dept.
Aneurin Bevan House
81 Commercial Road
London
E1 5RD
Tel 020 7092 5133
07891110253
Email eunan.o’neill@nhs.net
99
[borough Logo here]
borough address
C
Our ref
Date:
Dear
Thank you for taking part in this survey. I am able to give you some feedback about the examination
if you would like.
It is important to understand that the survey is not designed to collect the sort of information on
which dental treatment can be planned. We are not in a dental surgery so we do not have access to
air (to dry the teeth) or radiographs (to help us see beyond a clinical examination in some areas).
The examination is not the same as visiting a general dental practitioner which is the best way of
ensuring a thorough check-up.
Having looked at your mouth there are some teeth that would benefit from a closer inspection and I
would recommend that you make an appointment to see a dentist in the next couple of weeks.
Yours Sincerely
(Dentist Signature)
Study of the oral health status and dental service use of older adults in City & Hackney, Tower
Hamlets and Newham
100

The Oral Health of Older Adults in East London

Transcription

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