Dental caries and periodontal disease in Fiji G. N. Davies* P. Hedrickt J. Luvenit V. Pal4 D. Singhll
Key words: Caries, epidemiology, oral health survey, periodontal disease. Abstract A national oral survey was conducted in Fiji in 1985186. The results showed that the prevalence of caries was generally low and most commonly affected pit and fissure surfaces. Comparisons with previous surveys in 1948 and 1965 showed that the prevalence had fallen in primary teeth but remained relatively constant in permanent teeth. There were significant variations in prevalence between residential locations but not between ethnic groups. Periodontal disease was found to be a major public health problem. Except for the percentage of young children with caries-free dentitions, the current status of oral health in Fiji was generally better than that proposed in the WHO goals for the year 2000. The training d dental hygienists to help in the prevention of both dental caries and periodontal disease is discussed. (Received for publication May 1991. Revised September 1991. Accepted December 1991.)
Introduction In 1985/86 a national oral health survey was conducted in Fiji of 4326 persons aged 5 to 55 years and over.
*Former Dean, Faculty of Dentistry, and Deputy Vice-Chancellor (Academic), University of Queensland. ?World Health Organization Statistician, Suva, Fiji. $Former Senior Dental Officer, Dental Services, Fiji. §Divisional Dental Officer, CentrallEastern Region, Fiji. (1 Former Assistant Director, Dental Services, Fiji. 386
The purposes of the survey were to obtain data: (1) to assist in the planning of an oral health service for Fiji; (2) to provide guide-lines for determining the emphasis which should be placed on preventive, health education, curative and rehabilitative services; and (3) to determine temporal changes in the prevalence of dental caries. Records were available from two previous ‘national’ surveys by Davies and Vosailagi in 1948/49’ and by Wong2 in 1965. The first involved the examination of 836 persons aged 2 to 28 years in the urban area of Suva and 33 villages. The second involved 5478 urban and rural subjects aged 3 to 54 years in Suva and more than 120 villages.
Methods The methods of examination and criteria in the three ‘national’ surveys were similar to those described for dental caries in the 1977 edition of the World Health Organization manual Oral Health Surveys - Basic Methods3 However, the assessments of periodontal disease differed. The CPITN methodology was confined to the 1985/86 national survey. A stratified cluster sampling procedure was adopted to allow for expected variations due to age, sex, urban and rural residence and Fijian and Indian ethnic groups. This made it possible to bring the survey within the limits of the available resources. It was planned to have clusters of 20 households each in urban areas and Indian settlements and 10 households in each Fijian village. One household was selected at random from each cluster. ExaminaAustralian Dental Journal 1992;37(5):386-93.
Mean dmft and DMFT per child
2.2
5-6
7-8
9-10
5-6
11-12
7-8
Agelprimary teeth
9-10
11-12
13-14
Agelpermanent teeth
0Missing
Decayed
Filled
Fig. 1.-Decayed, missing and filled primary and permanent teeth in children aged 5-14 years.
Table 1. Distribution of subjects by age, residential location, ethnic group and sex Urban Age in
Indian
Rural Other
Fijian
Indian
Fijian
Other Total
years
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
5-6 7-8 9-10 11-12 13-14 15-19 20-24 25-29 30-34 35-44 45-54 55 + Total
10 22 29 16 16 44 59 45 30 48 39 35 393
16 15 13 17 19 48 64 48 28 66 37 38 409
17 21 19 14 16 34 27 15 15 37 31 23 269
18 17 21 18 16 47 49 30 24 56 33 24 353
3 2 1 2 3 9 11 9 6 5 2 8 61
3 5 2 1 2 9 10 12 6 10 4 5 69
42 43 46 31 32 68 69 74 51 72 55 51 634
49 33 41 23 29 90 76 72 46 99 46 42 646
43 50 50 49 29 64 79 60 53 82 50 89 698
55 45 49 44 35 89 96 74 55 83 68 80 773
-
1 2
tions were then done for that household and for the 9 or 19 households surrounding it. Checks were made to ensure that the population in each cluster was comparable with the population at the 1976 census. A calibration training course was held in Suva for the ten examiners and nine recorders. The basic training document was the WHO Oral Health Surveys Manual3 supplemented by additional material prepared by Mrs V. Naroba, Ministry of Health Statistician, Mr P. Hedrick, WHO Statistician, and Mr S. Balekiwai from the Bureau of Statistics. The trials consisted of examiners recording findings on each other followed by the examination of patients attendmg the Suva Clinic and field trials at a squatter settlement in Suva and three villages at Navua. Australian Dental Journal 1992;37:5.
1 2 1
1
-
2 2 1 2 12
1 1 1 1
1
1 9
257 256 273 216 198 504 54 1 440 316 56 1 366 398 4326
Each of the trials was followed by lengthy discussions of dificult cases encountered. A final assessment of the results from pairs of examiners revealed a high degree of consistency for both teeth requiring treatment and DMFT. Student t test analyses showed differences significant at the levels of only 10 and 20 per cent. The distribution of the sample by age, sex, residential location and ethnic group is shown in Table 1.
Results Dental caries The prevalence of caries in primary teeth reached a peak at 85 per cent of 7-8 year olds with a mean 387
18 41
20
15-19
20-24
25-29
30-34
35-44
45-54
55+
Age in years Decayed
Filled
0Missing for caries
Missing any reason
Fig. 2.-Decayed, missing and filled permanent teeth in adults aged 15-55 +years.
Percentage of children by worst score 100%
75%
50%
25%
0% 5-6
9-10
7-0
11-12
13-14
Age in years
0Healthy
Bleeding
Calculus
Fig. 3.-Percentage distribution of children aged 5-14 years by worst CPITN score.
of 3.9 affected teeth per child. At that age half of the affected teeth were decayed, 44 percent had been extracted and 4 per cent were filled (Fig. 1). In children, the prevalence of caries in permanent teeth rose from 6 per cent affected at age 5-6 to 69 per cent at age 13-14 with mean numbers of teeth affected per child of 0.1 at age 5-6 to 2.2 at age 13-14 (Fig. 1). In adults, the percentage of persons with one or more decayed, missing and filled teeth rose from 73 per cent at age 15-19 to 98 per cent at age 55 years and over. The mean numbers of affected teeth 300
per person rose from 2.9 at age 15-19 to 8. I- at age 55 ;ears and over. Of theserat age 15-19, 57 per cent were decayed, 18 per cent had been extracted and 24 per cent had been filled. At age 55 years and over 9 per cent were decayed, 90 per cent had been extracted and 1 per cent filled (Fig. 2). It should be noted that the criteria in the 1977 WHO Manual, which was used in this survey, provided for the recording of M teeth at age 30 years and over as missing for any reason. No distinction was made between teeth lost because of caries or other reason such as periodontal disease as was done in the third edition of the Manual (1987). Australian Dental Journal 1992;37:5.
Percentage of persons by worst score 100%
75%
50%
25%
0% 1519
20-24
25-29
30-34
35-44
45-54
55
+
Age in years
w
0Healthy
n
4-5 mm pockets
Bleeding
w
w
Calculus
6 + mm pockets
Fig. 4. -Percentage distribution of adults aged 15-55 + years by worst CPITN score.
Table 2. Periodontal disease in adults Item
Age 15-19 20-24 25-29 30-34 35-44 45-54 55 +
Yo with periodontal disease Yo with gingivitis only Yo with gingivitis and calculus Yo with shallow pockets Yo with deep pockets Mean number healthy sextants Mean number sextants with bleeding Mean number sextants with calculus Mean number sextants with shallow pockets Mean number sextants with deep pockets Mean number exluded sextants
72 14
80 9
87 7
96 3
94 6
98 3
96 1
58 1
69 2 0
88 4 1
74 13 1
79 15
0
75 5 1
1
74 18 2
2.6
2.0
1.3
1.3
1.0
0.7
0.9
0.8
0.6
0.5
0.3
0.2
2.4
2.9
3.4
3.1
2.8
1.8
0.03 0.1
0.1
0.2
0.3
0.3
0.0
0.0
-
-
-
-
0.1
0.3
0.6
0.9
1.7
3.0
Periodontal disease The prevalence of periodontal disease in children rose from 11 per cent affected at age 5-6 to 57 per cent at age 13-14. The proportions with gingival bleeding and calculus as the worst condition present rose from 7 to 18 per cent and 4 to 39 per cent, respectively (Fig. 3). Periodontal disease became an increasingly serious problem with advancing age. The percentage of persons with healthy periodontal tissues fell from 28 per cent at age 15-19 years to 4 per cent at age 55 years and over. Calculus dominated the periodontal Australian Dental Journal 1992;37:5.
picture. It was present as the worst CPITN score in 58 per cent of 15-19 year olds and in 74 per cent of those aged 55 years and over. The presence of periodontal pockets ranged from 1 per cent of persons affected at age 15-19 years to 20 per cent at age 55 years and over. In the latter age group, 18 per cent of persons had shallow pockets (4-5 mm deep) and 2 per cent had deep pockets (6 or more mm deep) (Fig. 4 and Table 2).
Missing teeth Up to age 15-19 years very few permanent teeth were lost prematurely. After that age, however, the extraction rate rose steeply from means of 1.6 per person at age 20-24 years to 16.6 at age 55 years and over. Up to age 30, caries was the major cause of loss of teeth. After that age, periodontal disease and the need for dentures assumed increasingly significant roles (Fig. 5) but the criteria used did not make it possible to specify the extent to which caries or periodontal disease was responsible. The proportion of persons completely edentulous rose from 1 per cent at age 30-34 years to 22 per cent at age 55 years and over. Requirements for treatment In children, as primary teeth were shed and replaced by permanent teeth, the need for restorations fell from 4.7 per person at age 5-6 to 1.7 per person at age 13-14. The need for extractions also fell from 1.4-0.1 per person over the same age range. The requirements for restorations remained fairly constant at between one or two per person between the ages of 15 and 44. Thereafter the need for 389
Average per person
20 16.6
15
10
.
5 0.5
0.1
0.1
0.2
0.4
5-6
7-8
9-10
11-12 1514
0.5
0 15-19 20-24 25-29 30-34 35-44 45-54
55t
Age in years Missing-caries Missing-other Fig. 5.-Mean numbers of missing teeth per person in subjects aged 5-55 + years. Percentage of adults requiring care
100
80 60
40 20 0
15-19
20-24
25-29
30-34
3544
45-54
55+
Age in years Oral hygiene instruction
~
Prophylaxis, scaling and oral hygiene instruction
Complex treatment
Fig. 6.- Percentage distribution of adults aged 15-55 + years requiring periodontal care.
Table 3. Treatment needs for dental caries Treatment requiredperson Age in years 5-6 7-0 9-10 11-12 13-14 15-19 2@24 25-29 30-34 35-44 45-54 55 +
One-surface Two-surface filling filling 1.9 2.1
2.7 1.9
1.6
1.1
1.5 2.1 1.2 1.3 1.3 1.2 0.7 0.5 0.2
0.2 0.3 0.3 0.1 0.5
-
0.4 0.3 0.2
Three-surface filling
’ Three-surface filling -
*
0.0 0.0
0.0 0.0 0.0
One-surface fillings as yo of total 4.7 4.0 2.7 1.7 2.5 1.5 1.4 1.8 1.3 1.1 0.9 0.4
41.4 51.3 58.6 89.6 85.8 79.3 95.7 71.7 93.8 61.9 62.1 55.0
1.4 1.o 0.4 0.3 0.1 0.2 0.3 0.4 0.5 0.6 0.6 1.2
*(-)=less than 0.1.
390
Australian Dental Journal 1992;37:5.
Mean number affected teeth per person
4.2 3.6
1.7
0.3 5-6
7-8
=
9-10
0.3
11-12
Age in years
Wong, 1965
=
National, 1985/86
Fig. 7.-Time changes in the mean number of decayed, missing and filled primary teeth of children aged 5-12 years over the years 1965-198986.
restorations fell as the need for extractions rose. A conspicuous feature of the need for restorations is that between the ages of 7-8 and 30-44 one-surface fillings were the major requirement; rising from 51 per cent of all fillings at age 7-8 to 93.8 per cent at age 30-44 (Table 3). Eleven to 57 per cent ofchildren aged 5-14 years required oral hygiene instruction, prophylaxes and scaling for the interception and control of gingivitis. Seventy-three to 98 per cent of adults required periodontal care. The major requirement was for oral hygiene instruction, prophylaxes and scaling. Only 2 per cent of adults aged 55 and over required complex treatment for advanced destructive disease (Fig. 6). The actual prevalence of deep periodontal pockets was probably much higher than would appear from this statement since for many the condition had already been treated by extraction. Thirty-four per cent had fewer than ten teeth present. The need for dentures rose from 6 per cent of persons at age 15-19 years to 71 per cent at age 55 years and over. The major requirement was for upper dentures (6-65 per cent) followed by full upper and lower dentures (0-5 per cent) and lower dentures (0-2 per cent). At the time of the survey, 13 per cent of those aged 55 and over were wearing upper dentures, 0.3 per cent lower dentures, and 7.2 per cent full upper and lower dentures.
Relationship of the present position to international goals The data in Table 4 show that, at the time of the survey, the position was better than the goals set Australian Dental Journal 1992;37:5.
Table 4. Comparison between the present position in Fiji and international goals for oral health by the year 2000 Item Subjects with cariesfree dentitions Mean number DMF Teeth Retain all permanent teeth Retain 20 functional teeth Mean number healthy sextants Mean number periodontal pockets
Age in years WHO goal Fiji 1985/86 5-6
50%
18.7%
12
3.0
1.25
18
85%
99%
35-44
75%
85.4%
12
3.0
4.1
15
0.0
0.0
by the World Health Organization for the mean number of DMF permanent teeth at age 12, the percentage who had retained all their permanent teeth at age 18, the percentage of persons at age 35 to 44 with 20 functional permanent teeth and the state of the periodontal tissues at age 12 and 15 years. Considerable improvement, however, is still necessary in the percentage of five to six-yearolds with caries-free dentitions.
Temporal changes in the prevalence of caries Between 1965 and 1985186 there was a substantial fall in the mean number of primary teeth with caries experience of the order of 30 to 40 per cent between the ages of 5-6 and 7-8 (Fig. 7). No such trend was apparent in the permanent dentition 39 1
30 25 20 15
l0 o 5
s .
7-8
9-10
11-12
=
1514
1519
20-24
25-29
30-34
35-44
45-54
=
Age in years
Wong, 1965
National, 1985/86
Fig. 8.-Time changes in the mean number of DMF permanent teeth of persons aged 7-54 years over the years 1965-1985/86.
either from 1965 to 1985/86 when the results were almost identical (Fig. 8); or between 1948, 1965 and 1985/86. Variations in the prevalence of caries between residential locations The 1948 survey disclosed highly significant differences at age 14-15 between the numbers of DMFT in urban areas (12.3 per person), remote river villages (7.1 per person) and isolated coastal villages (3.3 per person) P
Key words: Caries, epidemiology, oral health survey, periodontal disease. Abstract A national oral survey was conducted in Fiji in 1985186. The results showed that the prevalence of caries was generally low and most commonly affected pit and fissure surfaces. Comparisons with previous surveys in 1948 and 1965 showed that the prevalence had fallen in primary teeth but remained relatively constant in permanent teeth. There were significant variations in prevalence between residential locations but not between ethnic groups. Periodontal disease was found to be a major public health problem. Except for the percentage of young children with caries-free dentitions, the current status of oral health in Fiji was generally better than that proposed in the WHO goals for the year 2000. The training d dental hygienists to help in the prevention of both dental caries and periodontal disease is discussed. (Received for publication May 1991. Revised September 1991. Accepted December 1991.)
Introduction In 1985/86 a national oral health survey was conducted in Fiji of 4326 persons aged 5 to 55 years and over.
*Former Dean, Faculty of Dentistry, and Deputy Vice-Chancellor (Academic), University of Queensland. ?World Health Organization Statistician, Suva, Fiji. $Former Senior Dental Officer, Dental Services, Fiji. §Divisional Dental Officer, CentrallEastern Region, Fiji. (1 Former Assistant Director, Dental Services, Fiji. 386
The purposes of the survey were to obtain data: (1) to assist in the planning of an oral health service for Fiji; (2) to provide guide-lines for determining the emphasis which should be placed on preventive, health education, curative and rehabilitative services; and (3) to determine temporal changes in the prevalence of dental caries. Records were available from two previous ‘national’ surveys by Davies and Vosailagi in 1948/49’ and by Wong2 in 1965. The first involved the examination of 836 persons aged 2 to 28 years in the urban area of Suva and 33 villages. The second involved 5478 urban and rural subjects aged 3 to 54 years in Suva and more than 120 villages.
Methods The methods of examination and criteria in the three ‘national’ surveys were similar to those described for dental caries in the 1977 edition of the World Health Organization manual Oral Health Surveys - Basic Methods3 However, the assessments of periodontal disease differed. The CPITN methodology was confined to the 1985/86 national survey. A stratified cluster sampling procedure was adopted to allow for expected variations due to age, sex, urban and rural residence and Fijian and Indian ethnic groups. This made it possible to bring the survey within the limits of the available resources. It was planned to have clusters of 20 households each in urban areas and Indian settlements and 10 households in each Fijian village. One household was selected at random from each cluster. ExaminaAustralian Dental Journal 1992;37(5):386-93.
Mean dmft and DMFT per child
2.2
5-6
7-8
9-10
5-6
11-12
7-8
Agelprimary teeth
9-10
11-12
13-14
Agelpermanent teeth
0Missing
Decayed
Filled
Fig. 1.-Decayed, missing and filled primary and permanent teeth in children aged 5-14 years.
Table 1. Distribution of subjects by age, residential location, ethnic group and sex Urban Age in
Indian
Rural Other
Fijian
Indian
Fijian
Other Total
years
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
5-6 7-8 9-10 11-12 13-14 15-19 20-24 25-29 30-34 35-44 45-54 55 + Total
10 22 29 16 16 44 59 45 30 48 39 35 393
16 15 13 17 19 48 64 48 28 66 37 38 409
17 21 19 14 16 34 27 15 15 37 31 23 269
18 17 21 18 16 47 49 30 24 56 33 24 353
3 2 1 2 3 9 11 9 6 5 2 8 61
3 5 2 1 2 9 10 12 6 10 4 5 69
42 43 46 31 32 68 69 74 51 72 55 51 634
49 33 41 23 29 90 76 72 46 99 46 42 646
43 50 50 49 29 64 79 60 53 82 50 89 698
55 45 49 44 35 89 96 74 55 83 68 80 773
-
1 2
tions were then done for that household and for the 9 or 19 households surrounding it. Checks were made to ensure that the population in each cluster was comparable with the population at the 1976 census. A calibration training course was held in Suva for the ten examiners and nine recorders. The basic training document was the WHO Oral Health Surveys Manual3 supplemented by additional material prepared by Mrs V. Naroba, Ministry of Health Statistician, Mr P. Hedrick, WHO Statistician, and Mr S. Balekiwai from the Bureau of Statistics. The trials consisted of examiners recording findings on each other followed by the examination of patients attendmg the Suva Clinic and field trials at a squatter settlement in Suva and three villages at Navua. Australian Dental Journal 1992;37:5.
1 2 1
1
-
2 2 1 2 12
1 1 1 1
1
1 9
257 256 273 216 198 504 54 1 440 316 56 1 366 398 4326
Each of the trials was followed by lengthy discussions of dificult cases encountered. A final assessment of the results from pairs of examiners revealed a high degree of consistency for both teeth requiring treatment and DMFT. Student t test analyses showed differences significant at the levels of only 10 and 20 per cent. The distribution of the sample by age, sex, residential location and ethnic group is shown in Table 1.
Results Dental caries The prevalence of caries in primary teeth reached a peak at 85 per cent of 7-8 year olds with a mean 387
18 41
20
15-19
20-24
25-29
30-34
35-44
45-54
55+
Age in years Decayed
Filled
0Missing for caries
Missing any reason
Fig. 2.-Decayed, missing and filled permanent teeth in adults aged 15-55 +years.
Percentage of children by worst score 100%
75%
50%
25%
0% 5-6
9-10
7-0
11-12
13-14
Age in years
0Healthy
Bleeding
Calculus
Fig. 3.-Percentage distribution of children aged 5-14 years by worst CPITN score.
of 3.9 affected teeth per child. At that age half of the affected teeth were decayed, 44 percent had been extracted and 4 per cent were filled (Fig. 1). In children, the prevalence of caries in permanent teeth rose from 6 per cent affected at age 5-6 to 69 per cent at age 13-14 with mean numbers of teeth affected per child of 0.1 at age 5-6 to 2.2 at age 13-14 (Fig. 1). In adults, the percentage of persons with one or more decayed, missing and filled teeth rose from 73 per cent at age 15-19 to 98 per cent at age 55 years and over. The mean numbers of affected teeth 300
per person rose from 2.9 at age 15-19 to 8. I- at age 55 ;ears and over. Of theserat age 15-19, 57 per cent were decayed, 18 per cent had been extracted and 24 per cent had been filled. At age 55 years and over 9 per cent were decayed, 90 per cent had been extracted and 1 per cent filled (Fig. 2). It should be noted that the criteria in the 1977 WHO Manual, which was used in this survey, provided for the recording of M teeth at age 30 years and over as missing for any reason. No distinction was made between teeth lost because of caries or other reason such as periodontal disease as was done in the third edition of the Manual (1987). Australian Dental Journal 1992;37:5.
Percentage of persons by worst score 100%
75%
50%
25%
0% 1519
20-24
25-29
30-34
35-44
45-54
55
+
Age in years
w
0Healthy
n
4-5 mm pockets
Bleeding
w
w
Calculus
6 + mm pockets
Fig. 4. -Percentage distribution of adults aged 15-55 + years by worst CPITN score.
Table 2. Periodontal disease in adults Item
Age 15-19 20-24 25-29 30-34 35-44 45-54 55 +
Yo with periodontal disease Yo with gingivitis only Yo with gingivitis and calculus Yo with shallow pockets Yo with deep pockets Mean number healthy sextants Mean number sextants with bleeding Mean number sextants with calculus Mean number sextants with shallow pockets Mean number sextants with deep pockets Mean number exluded sextants
72 14
80 9
87 7
96 3
94 6
98 3
96 1
58 1
69 2 0
88 4 1
74 13 1
79 15
0
75 5 1
1
74 18 2
2.6
2.0
1.3
1.3
1.0
0.7
0.9
0.8
0.6
0.5
0.3
0.2
2.4
2.9
3.4
3.1
2.8
1.8
0.03 0.1
0.1
0.2
0.3
0.3
0.0
0.0
-
-
-
-
0.1
0.3
0.6
0.9
1.7
3.0
Periodontal disease The prevalence of periodontal disease in children rose from 11 per cent affected at age 5-6 to 57 per cent at age 13-14. The proportions with gingival bleeding and calculus as the worst condition present rose from 7 to 18 per cent and 4 to 39 per cent, respectively (Fig. 3). Periodontal disease became an increasingly serious problem with advancing age. The percentage of persons with healthy periodontal tissues fell from 28 per cent at age 15-19 years to 4 per cent at age 55 years and over. Calculus dominated the periodontal Australian Dental Journal 1992;37:5.
picture. It was present as the worst CPITN score in 58 per cent of 15-19 year olds and in 74 per cent of those aged 55 years and over. The presence of periodontal pockets ranged from 1 per cent of persons affected at age 15-19 years to 20 per cent at age 55 years and over. In the latter age group, 18 per cent of persons had shallow pockets (4-5 mm deep) and 2 per cent had deep pockets (6 or more mm deep) (Fig. 4 and Table 2).
Missing teeth Up to age 15-19 years very few permanent teeth were lost prematurely. After that age, however, the extraction rate rose steeply from means of 1.6 per person at age 20-24 years to 16.6 at age 55 years and over. Up to age 30, caries was the major cause of loss of teeth. After that age, periodontal disease and the need for dentures assumed increasingly significant roles (Fig. 5) but the criteria used did not make it possible to specify the extent to which caries or periodontal disease was responsible. The proportion of persons completely edentulous rose from 1 per cent at age 30-34 years to 22 per cent at age 55 years and over. Requirements for treatment In children, as primary teeth were shed and replaced by permanent teeth, the need for restorations fell from 4.7 per person at age 5-6 to 1.7 per person at age 13-14. The need for extractions also fell from 1.4-0.1 per person over the same age range. The requirements for restorations remained fairly constant at between one or two per person between the ages of 15 and 44. Thereafter the need for 389
Average per person
20 16.6
15
10
.
5 0.5
0.1
0.1
0.2
0.4
5-6
7-8
9-10
11-12 1514
0.5
0 15-19 20-24 25-29 30-34 35-44 45-54
55t
Age in years Missing-caries Missing-other Fig. 5.-Mean numbers of missing teeth per person in subjects aged 5-55 + years. Percentage of adults requiring care
100
80 60
40 20 0
15-19
20-24
25-29
30-34
3544
45-54
55+
Age in years Oral hygiene instruction
~
Prophylaxis, scaling and oral hygiene instruction
Complex treatment
Fig. 6.- Percentage distribution of adults aged 15-55 + years requiring periodontal care.
Table 3. Treatment needs for dental caries Treatment requiredperson Age in years 5-6 7-0 9-10 11-12 13-14 15-19 2@24 25-29 30-34 35-44 45-54 55 +
One-surface Two-surface filling filling 1.9 2.1
2.7 1.9
1.6
1.1
1.5 2.1 1.2 1.3 1.3 1.2 0.7 0.5 0.2
0.2 0.3 0.3 0.1 0.5
-
0.4 0.3 0.2
Three-surface filling
’ Three-surface filling -
*
0.0 0.0
0.0 0.0 0.0
One-surface fillings as yo of total 4.7 4.0 2.7 1.7 2.5 1.5 1.4 1.8 1.3 1.1 0.9 0.4
41.4 51.3 58.6 89.6 85.8 79.3 95.7 71.7 93.8 61.9 62.1 55.0
1.4 1.o 0.4 0.3 0.1 0.2 0.3 0.4 0.5 0.6 0.6 1.2
*(-)=less than 0.1.
390
Australian Dental Journal 1992;37:5.
Mean number affected teeth per person
4.2 3.6
1.7
0.3 5-6
7-8
=
9-10
0.3
11-12
Age in years
Wong, 1965
=
National, 1985/86
Fig. 7.-Time changes in the mean number of decayed, missing and filled primary teeth of children aged 5-12 years over the years 1965-198986.
restorations fell as the need for extractions rose. A conspicuous feature of the need for restorations is that between the ages of 7-8 and 30-44 one-surface fillings were the major requirement; rising from 51 per cent of all fillings at age 7-8 to 93.8 per cent at age 30-44 (Table 3). Eleven to 57 per cent ofchildren aged 5-14 years required oral hygiene instruction, prophylaxes and scaling for the interception and control of gingivitis. Seventy-three to 98 per cent of adults required periodontal care. The major requirement was for oral hygiene instruction, prophylaxes and scaling. Only 2 per cent of adults aged 55 and over required complex treatment for advanced destructive disease (Fig. 6). The actual prevalence of deep periodontal pockets was probably much higher than would appear from this statement since for many the condition had already been treated by extraction. Thirty-four per cent had fewer than ten teeth present. The need for dentures rose from 6 per cent of persons at age 15-19 years to 71 per cent at age 55 years and over. The major requirement was for upper dentures (6-65 per cent) followed by full upper and lower dentures (0-5 per cent) and lower dentures (0-2 per cent). At the time of the survey, 13 per cent of those aged 55 and over were wearing upper dentures, 0.3 per cent lower dentures, and 7.2 per cent full upper and lower dentures.
Relationship of the present position to international goals The data in Table 4 show that, at the time of the survey, the position was better than the goals set Australian Dental Journal 1992;37:5.
Table 4. Comparison between the present position in Fiji and international goals for oral health by the year 2000 Item Subjects with cariesfree dentitions Mean number DMF Teeth Retain all permanent teeth Retain 20 functional teeth Mean number healthy sextants Mean number periodontal pockets
Age in years WHO goal Fiji 1985/86 5-6
50%
18.7%
12
3.0
1.25
18
85%
99%
35-44
75%
85.4%
12
3.0
4.1
15
0.0
0.0
by the World Health Organization for the mean number of DMF permanent teeth at age 12, the percentage who had retained all their permanent teeth at age 18, the percentage of persons at age 35 to 44 with 20 functional permanent teeth and the state of the periodontal tissues at age 12 and 15 years. Considerable improvement, however, is still necessary in the percentage of five to six-yearolds with caries-free dentitions.
Temporal changes in the prevalence of caries Between 1965 and 1985186 there was a substantial fall in the mean number of primary teeth with caries experience of the order of 30 to 40 per cent between the ages of 5-6 and 7-8 (Fig. 7). No such trend was apparent in the permanent dentition 39 1
30 25 20 15
l0 o 5
s .
7-8
9-10
11-12
=
1514
1519
20-24
25-29
30-34
35-44
45-54
=
Age in years
Wong, 1965
National, 1985/86
Fig. 8.-Time changes in the mean number of DMF permanent teeth of persons aged 7-54 years over the years 1965-1985/86.
either from 1965 to 1985/86 when the results were almost identical (Fig. 8); or between 1948, 1965 and 1985/86. Variations in the prevalence of caries between residential locations The 1948 survey disclosed highly significant differences at age 14-15 between the numbers of DMFT in urban areas (12.3 per person), remote river villages (7.1 per person) and isolated coastal villages (3.3 per person) P
