International Journal of Paediatric Dentistry 1992; 2: 87-9 1
Dental caries in 12-year-old children in Salford, UK: changes over 28 years J. G. WHITTLE’ & KATHERINE W. DAVIES2 Department of Dental Public Health, Salford and Trafford Health Authorities Tornmunity Dental Service, Salford Health Authority
Summary. A sample of 1 11 12-year-old children in Salford, UK was examined in 1988,and the findingscompared with those of a survey camed out in 1960of 12-yearold children in the same city. Between 1960 and 1988, the mean DMFTof the boys fell from 6.04 to 2-34 and that of the girls from 6.54 to 3.40. All types of teeth were affected by canes in 1960 but in 1988 none of the canines and mandibular lateral incisors were affected. In 1960 the permanent first molars contributed 57% of the boys’ and 54% of the girls’ total DMFT while in 1988 they contributed 87% of the boys’ and 73% of the girls’ DMFT. Jackson’s Treatment Index showed that the dental services were making a greater impact in 1988;for the boys it rose from 29.5 to 63.2 and for the girls from 27-8 to 62.3.
Introduction In 1960, Hargreaves [ 11 examined a sample of 12year-old children living in Salford, UK. He reported a high prevalence of dental disease, provided information about the susceptibility of individual teeth to caries, and used the Treatment Index (TI) of Jackson [2] to illustrate that a low level of treatment was being provided. Since then many studies have shown a decline in caries levels. For example, surveys of a slightly younger age group in Salford found that the DMFT had fallen from 3.95 to 3-16 between 1975-76 and 1981-82 131. However, less attention has been paid to individual teeth to find out whether they have been affected differentially or whether there has been a uniform decline throughout the mouth, although the report of the 1983 children’s dental health survey [4] showed that the caries experience of four teeth (the maxillary left primary and permanent central incisors, and the mandibular left primary and permanent first molars) declined between 1973 and 1983; data for other teeth were not reported. Correspondence and reprint requests to: Dr J. G. Whittle, Salford and Trafford Health Authorities, 8th Floor, Peel House, Eccles, Manchester M30 ONJ,UK.
The aims of this study, therefore, were to measure changes in dental caries that had occurred in 12-year-old children in the city since 1960, to find out if the relative susceptibility of individual teeth had altered and to compare the level of treatment provided in 1988 with that reported in 1960.
Methods All seven secondary schools within the 1960 boundaries of Salford were included in the study. At this time 12-year-old children were being examined as part of the cycle of dental epidemiological surveys in schoolsco-ordinated by the British Association for the Study of Community Dentistry [ 5 ] . For this purpose a sample of one in seven children was required. Although a sample of this size was smaller than that used by Hargreaves it was calculated that it would be large enough to show statistically signficant differences in view of the likely changes in caries experience over the 28 years. Therefore, one in seven children were randomly selected for examination. Some extra children were also chosen to act as reserves in case a child refused to be seen or was absent on the day the school was visited. A letter describing the 87
88
J. G. Whittle & K. W. Davies
survey and asking for co-operation was sent to the parents of the selected children. The 1960 study used a tactile examination technique which was described in detail by Jackson [6]. A pit or fissure was counted as carious if, with a little pressure, the point of a sharp probe stuck and a definite pull was required to remove it. Approximal lesions were considered detectable if the probe caught roughened surface or definite cavity. The use of a sharp probe in collecting prevalence data may now be considered undesirable as it has been shown that it can damage the integrity of partially demineralized surface enamel [71. Therefore the 1988 survey followed the method recommended by the British Association for the Study of Community Dentistry for prevalence studies [5]. The dental examinations were carried out in the schools using a portable reclining chair. The mouth was illuminated by a 60-watt bulb in an anglepoise lamp and the teeth were dried using compressed air. The diagnosis of caries was based on visual criteria, a blunt probe being available to clean the fissures and free smooth surfaces to improve observation. All teeth were systematically examined and caries was recorded where there was a visible breakdown of enamel resulting in cavitation, or an unquestionable shadow or opacity beneath enamel. Where doubt existed the lesion was tested gently with the blunt probe. Unless the tip entered the lesion the site was regarded as sound. As in 1960 one examiner (KWD) collected all the data. These were recorded in numerical code on SPEED (System for Planning and Epidemiological Evaluation of Dental Services) charts [8,9], and were subsequently recorded on magnetic tape for analysis by the SPEED suite of programs. Ninety-five per cent confidence intervals were calculated for the mean DMFT scores. The Treatment Index (TI) of Jackson [2] was calculated from the formula: TI =
+
+
3(F/DMP/o) 2(FC/DMP/o) (MIDMPh) 3
9
where D = decayed teeth, M = missing teeth presumed extracted because of caries, FC= teeth filled but at the same time carious, and F=filled teeth but otherwise sound. The nature of the TI makes it unsuitable for statistical testing.
Results Fifty-nine boys and 52 girls were examined. This compared with 303 boys and 203 girls in the 1960 survey. Table 1 shows the caries experience of the children. There had been a 61Oh reduction in DMFT in boys, from 6.04 in 1960 to 2.34 in 1988, and a 48% reduction in girls, from 6-54 to 3.40. Both these reductions were significant. Table 1. Caries experience of Salford 12-year-old children in 1960 and 1988 (mean DMFT and 95% confidence intervals) Number of children
Mean DMFT
95% CI
1960 Boys Girls
303 203
6.04 6.54
5.65-6.43 6.09-7.00
1988 Boys Girls
59 52
2.34 3-40
1-85-2.83 2.63-4.17
In 1960 the TI was 29.5 for the boys and 27.8 for the girls (Table 2); approximately 60°h of the teeth affected by caries remained untreated and missing teeth made up 15% of the boys’ and 18% of the girls’ total DMFT scores. By 1988 the TI had risen to 63.2 for the boys and to 62.3 for the girls; about 25% of the teeth affected by caries had not been treated and missing teeth made up 12% of the boys’ and 10% of the girls’ total DMFT scores. Table 3 shows the caries experience of the permanent first molars. In 1960 the mean DMFT was 3.45 for the boys and 3.55 for thegirls. In 1988 the corresponding figures were 2-03 and 2.42. These represented reductions of 41% and 32%, respectively. The differences were again significant. The first molars contributed 57%of the total DMFT score of the boys in 1960 and this rose to 87%in 1988. For the girls it rose from 54%in 1960 to 71% in 1988. The TI for the first molars is shown in Table 4. Between 1960 and 1988 this rose from 37.4 to 70.6 for the boys and from 36.0 to 68.5 for the girls. Untreated disease fell from over 40% of the total DMFT in 1960 to 16% in 1988 while filled teeth rose from less than 30% to over 50%. Table 5 shows how the caries experience of each permanent tooth had changed between the two surveys. In 1960 88% of the boys’ and 86% of the
Dental caries in children in Salford
89
Table 2. Treatment Index (TI) for permanent dentition of 12-year-old children in 1960 and 1988 Numberof children
D/DMF %
M/DMF %
F/DMF %
FUDMF %
TI
1960 Boys Girls
303 203
59-6 58.9
14.6 18.4
22.0 19.5
3.9 3.3
29.5 27.8
1988 Boys Girls
59 52
24.6 26.0
12.3 9.6
51.4 48.6
11-6 15.8
63-2 62.3
Table 3. Caries experience of permanent first molars and their percentage contribution to total DMFT scores in 1960 and 1988 (mean DMFT and 95% confidence intervals) Contribution of total DMFT
Number of children
Mean DMFT
95% CI
1960 Boys Girls
303 203
3.45 3.55
3.35-3.55 3.42-3.68
57 54
1988 Boys Girls
59 52
2.03 2.42
1.64-2.43 1.99-2.85
87 73
%
Table 4. Treatment Index (TI) for permanent first molars of 12-year-old children in 1960 and 1988 Numberof children
D/DMF
M/DMF
96
%
F/DMF %
FC/DMF %
TI
1960 Boys Girls
303 203
45.2 42.1
23.3 30-7
26.0 22-8
5.4 4.4
37.4 36.0
1988 Boys Girls
59 52
15.8 15.9
14.2 13.5
57.5
50.8
12.5 19.8
70-6 68-5
girls' maxillary first molars had been attacked. The corresponding figures in 1988 were 56% and 6 1%. Similar changes were recorded for the mandibular first molar. Whereas every type of tooth had been affected by caries in 1960, several had not suffered in 1988; in the boys these were the canines, mandibular premolars and mandibular incisors and, in the girls, the canines and mandibular lateral incisors.
Discussion In order to make a true comparison of dental
health of 12-year-oldsin Salford in 1960 and 1988 the methods of examination should ideally have been the same. Nevertheless it can be concluded that dental health has improved because large, statistically significant changes were detected and the differences in the diagnostic methods were small. In fact the magnitude of the change may have been underestimated because a visual-tactile examination has been shown.to produce slightly higher DMFS scores than a purely visual assessment [ 101. Because the percentage reduction in caries experience was greater in anterior than in posterior
90
J. G. Whittle & K. W. Davies
Table 5. Percentage of individual permanent teeth affected by canes in 12-year-old children in 1960 and 1988 Maxillary teeth Number of children
1
2
I960 Boys Girls
303 203
9 13
12 13
0
1988 Boys Girls
59 52
2 6
1 11
0 0
3
1
4
11 9
I
5
6
7
1
2
3
4
5
6
7
12 13
88 86
30 41
3 4
2
0 1
3 3
10
1
85 92
38 47
6 61
6 11
0 1
0 0
0 0
0 2
5
1
posterior teeth, the first molars contributed a greater proportion to the total DMFT score in 1988 than in 1960 (Table 3). The presence of fissure sealants was not recorded and, although an impression was gained that there were few in number, some preventive resin restorations may have been present. Thus, caries in first molars in 1988 may have made up a greater proportion of the total DMFT than was recorded. Use of the Treatment Index was first advocated in 1961, yet it has never won universal acclaim, and there is now a feeling that indices should reflect the role of primary prevention rather than treatment [ 1 11. The TI was therefore less relevant in 1988 than in 1960 but its use has provided an appreciation of how dental services have coped with caries over the study period. The TI has a value of 33 when the M component accounts for the total DMFT score. Jackson considered that this level was equivalent to that of an efficient casualty service (although it might be argued that such a service would be expected to save some teeth). He felt that it was impossible to give an ideal optimum figure for the TI but thought that, theoretically, it should be possible to achieve a value of 80. The services in Salford were not even providing care at the casualty level in 1960 (Table 2). By 1988 there had been a great improvement but it is clear that more still needs to be done to reach the optimum level.
ResumB. Un Cnchantillon de 111 enfants AgCs de 12ans de Salford (Grande-Bretagne)a CtC examine en 1983 et les rksultats comparCs avec ceux d’une Ctude rCalisCe en 1960 chez des enfants iges de 12 ans de la mCme ville. Entre 1960 et 1988, la moyenne CAO est tombCe de 6.04 A 2-34 chez les garcons et de 6-54 a 3-40 chez les filles. Toutes les
Mandibular teeth
5
5
10
0 4 6 7 7 6 1 1 6
dents Ctaient atteintes par la carie en 1960mais en 1988 aucune canine et incisive latCrale inferieure n’ttait atteinte. En 1960, les premikres molaires permanentes contribuaient pour 57% chez les garcons et 54% chez les filles A l’indice CAO alors qu’en 1988 elles y contribuaient pour.
Zusammenfassung. In 1988 wurde eine Gruppe von 11 1; 12-jahrigen Kindern aus Salford untersucht. Die Befunde wurden verglichen mit dem Untersuch von 1960an gleichaltrigen Kindern der selben Stadt. Von 1960 bis 1988 fie1 der durchschnittliche DMFT-Index der Knaben von 6-04 auf 2-34. Der der Madchen von 6.54 auf 3-40. In 1960 waren noch alle m n e befallen. In 1988 keine der Eckzahne und der seitlichen unteren Schneidezahne. Die ersten Molaren machten 1960 noch 51% bei de Knaben und 54% bei den Madchen des gesammten DMFT aus. In 1988 waren es 87% resp. 73%. Der Jackson Behandlungsindex zeigte eine Erhohung der zahn-arztzlichen Leistungen von 29.5 zu 63-2bei den Knaben und von 27.8 zu 62.3 bei den Madchen. Resumen. Una muestra de 1 1 1niiios de 12 aiios de edad de Salford, Reino Unido, fue examinada en 1988 y 10shallazgos comparados con 10sobtenidos en un examen realizado en 1960 en niiios de 12 aiios de edad de la misma ciudad. Entre 1960 y 1988, la media DMFT de 10s niiios disminuy6 de 6.04 a 2-34 y en las hembras de 6.54 a 3-40. Todos 10s tipos de dientes fueron afectados por caries en 1960 mientras que en 1988ninguno de 10scaninos e incisivos laterales mandibulares fueron afectados. En 1960,los primeros molares permanentes contribuyeron a1 57% en 10s niiios y 54% en las niiias en el total de DMFT mientras que en 1988 contribuyeron al 87% en 10s niiios y 73% en las
Dental caries in children in Sarford niiias en el total de DMFT. El Indice de Tratamiento de Jackson mostro que 10s servicios odonto16gicos tuvieron mayor impacto en 1988; para 10s varones aument6 de 29.5 a 63.2 y para las hembras de 27-8 a 62.3
References Hargreaves JA. The problem of dental caries in child dental health. British Dental Journal 1964; 116 386-390. Jackson D. An index for assessing the efficacy of dental treatment in the control of dental canes. Dental Practitioner 1961; 11: 226-229. Whittle JG, Mackie IC, Sarll DW. Changes in the dental health of Salford secondary school children over six years. British Dental Journal 1983; 155 199-202. Todd JE, Dodd T. Children’s dental health in the United Kingdom 1983. London: HMSO, 1985. Palmer JD, Anderson RJ, Downer MC. Guidelines for
91
prevalence studies of dental canes. Community Dental Health 1984; 1: 55-61. 6 Jackson D. The clinical diagnosis of dental caries. British Dental Journal 1950; 88: 207-2 13. 7 Kay EJ, Watts A, Patterson RC,Blinkhorn AS. Preliminary investigationsinto the validity of dentists’ decisions to restore occlusal surfaces of permanent teeth. Community Dentistry and Oral Epidemiology 1988; 1 6 91-94. 8 Downer MC, Teagle FA, Whittle JG. Field testing of an information system for planning and evaluating dental services. Community Dentistry and Oral Epidemiology 1979; 7: 11-16.
9 Downer MC, Teagle FA. System forplanning & epidemiological evaluation of dental services. Manual. 2nd edn. Manchester: Department of Child Dental Health, 1984. 10 Howat AP, Holloway PJ, Brandt RS.The effect ofdiagnostic criteria on the sensitivity of dental epidemiological data. Caries Research 1981; 15: 117-123. 11 Sheiham A, Maizels J, Maizels A. New composite indicators of dental health. Community Dental Health 1987; 4 407-4 14.
Dental caries in 12-year-old children in Salford, UK: changes over 28 years J. G. WHITTLE’ & KATHERINE W. DAVIES2 Department of Dental Public Health, Salford and Trafford Health Authorities Tornmunity Dental Service, Salford Health Authority
Summary. A sample of 1 11 12-year-old children in Salford, UK was examined in 1988,and the findingscompared with those of a survey camed out in 1960of 12-yearold children in the same city. Between 1960 and 1988, the mean DMFTof the boys fell from 6.04 to 2-34 and that of the girls from 6.54 to 3.40. All types of teeth were affected by canes in 1960 but in 1988 none of the canines and mandibular lateral incisors were affected. In 1960 the permanent first molars contributed 57% of the boys’ and 54% of the girls’ total DMFT while in 1988 they contributed 87% of the boys’ and 73% of the girls’ DMFT. Jackson’s Treatment Index showed that the dental services were making a greater impact in 1988;for the boys it rose from 29.5 to 63.2 and for the girls from 27-8 to 62.3.
Introduction In 1960, Hargreaves [ 11 examined a sample of 12year-old children living in Salford, UK. He reported a high prevalence of dental disease, provided information about the susceptibility of individual teeth to caries, and used the Treatment Index (TI) of Jackson [2] to illustrate that a low level of treatment was being provided. Since then many studies have shown a decline in caries levels. For example, surveys of a slightly younger age group in Salford found that the DMFT had fallen from 3.95 to 3-16 between 1975-76 and 1981-82 131. However, less attention has been paid to individual teeth to find out whether they have been affected differentially or whether there has been a uniform decline throughout the mouth, although the report of the 1983 children’s dental health survey [4] showed that the caries experience of four teeth (the maxillary left primary and permanent central incisors, and the mandibular left primary and permanent first molars) declined between 1973 and 1983; data for other teeth were not reported. Correspondence and reprint requests to: Dr J. G. Whittle, Salford and Trafford Health Authorities, 8th Floor, Peel House, Eccles, Manchester M30 ONJ,UK.
The aims of this study, therefore, were to measure changes in dental caries that had occurred in 12-year-old children in the city since 1960, to find out if the relative susceptibility of individual teeth had altered and to compare the level of treatment provided in 1988 with that reported in 1960.
Methods All seven secondary schools within the 1960 boundaries of Salford were included in the study. At this time 12-year-old children were being examined as part of the cycle of dental epidemiological surveys in schoolsco-ordinated by the British Association for the Study of Community Dentistry [ 5 ] . For this purpose a sample of one in seven children was required. Although a sample of this size was smaller than that used by Hargreaves it was calculated that it would be large enough to show statistically signficant differences in view of the likely changes in caries experience over the 28 years. Therefore, one in seven children were randomly selected for examination. Some extra children were also chosen to act as reserves in case a child refused to be seen or was absent on the day the school was visited. A letter describing the 87
88
J. G. Whittle & K. W. Davies
survey and asking for co-operation was sent to the parents of the selected children. The 1960 study used a tactile examination technique which was described in detail by Jackson [6]. A pit or fissure was counted as carious if, with a little pressure, the point of a sharp probe stuck and a definite pull was required to remove it. Approximal lesions were considered detectable if the probe caught roughened surface or definite cavity. The use of a sharp probe in collecting prevalence data may now be considered undesirable as it has been shown that it can damage the integrity of partially demineralized surface enamel [71. Therefore the 1988 survey followed the method recommended by the British Association for the Study of Community Dentistry for prevalence studies [5]. The dental examinations were carried out in the schools using a portable reclining chair. The mouth was illuminated by a 60-watt bulb in an anglepoise lamp and the teeth were dried using compressed air. The diagnosis of caries was based on visual criteria, a blunt probe being available to clean the fissures and free smooth surfaces to improve observation. All teeth were systematically examined and caries was recorded where there was a visible breakdown of enamel resulting in cavitation, or an unquestionable shadow or opacity beneath enamel. Where doubt existed the lesion was tested gently with the blunt probe. Unless the tip entered the lesion the site was regarded as sound. As in 1960 one examiner (KWD) collected all the data. These were recorded in numerical code on SPEED (System for Planning and Epidemiological Evaluation of Dental Services) charts [8,9], and were subsequently recorded on magnetic tape for analysis by the SPEED suite of programs. Ninety-five per cent confidence intervals were calculated for the mean DMFT scores. The Treatment Index (TI) of Jackson [2] was calculated from the formula: TI =
+
+
3(F/DMP/o) 2(FC/DMP/o) (MIDMPh) 3
9
where D = decayed teeth, M = missing teeth presumed extracted because of caries, FC= teeth filled but at the same time carious, and F=filled teeth but otherwise sound. The nature of the TI makes it unsuitable for statistical testing.
Results Fifty-nine boys and 52 girls were examined. This compared with 303 boys and 203 girls in the 1960 survey. Table 1 shows the caries experience of the children. There had been a 61Oh reduction in DMFT in boys, from 6.04 in 1960 to 2.34 in 1988, and a 48% reduction in girls, from 6-54 to 3.40. Both these reductions were significant. Table 1. Caries experience of Salford 12-year-old children in 1960 and 1988 (mean DMFT and 95% confidence intervals) Number of children
Mean DMFT
95% CI
1960 Boys Girls
303 203
6.04 6.54
5.65-6.43 6.09-7.00
1988 Boys Girls
59 52
2.34 3-40
1-85-2.83 2.63-4.17
In 1960 the TI was 29.5 for the boys and 27.8 for the girls (Table 2); approximately 60°h of the teeth affected by caries remained untreated and missing teeth made up 15% of the boys’ and 18% of the girls’ total DMFT scores. By 1988 the TI had risen to 63.2 for the boys and to 62.3 for the girls; about 25% of the teeth affected by caries had not been treated and missing teeth made up 12% of the boys’ and 10% of the girls’ total DMFT scores. Table 3 shows the caries experience of the permanent first molars. In 1960 the mean DMFT was 3.45 for the boys and 3.55 for thegirls. In 1988 the corresponding figures were 2-03 and 2.42. These represented reductions of 41% and 32%, respectively. The differences were again significant. The first molars contributed 57%of the total DMFT score of the boys in 1960 and this rose to 87%in 1988. For the girls it rose from 54%in 1960 to 71% in 1988. The TI for the first molars is shown in Table 4. Between 1960 and 1988 this rose from 37.4 to 70.6 for the boys and from 36.0 to 68.5 for the girls. Untreated disease fell from over 40% of the total DMFT in 1960 to 16% in 1988 while filled teeth rose from less than 30% to over 50%. Table 5 shows how the caries experience of each permanent tooth had changed between the two surveys. In 1960 88% of the boys’ and 86% of the
Dental caries in children in Salford
89
Table 2. Treatment Index (TI) for permanent dentition of 12-year-old children in 1960 and 1988 Numberof children
D/DMF %
M/DMF %
F/DMF %
FUDMF %
TI
1960 Boys Girls
303 203
59-6 58.9
14.6 18.4
22.0 19.5
3.9 3.3
29.5 27.8
1988 Boys Girls
59 52
24.6 26.0
12.3 9.6
51.4 48.6
11-6 15.8
63-2 62.3
Table 3. Caries experience of permanent first molars and their percentage contribution to total DMFT scores in 1960 and 1988 (mean DMFT and 95% confidence intervals) Contribution of total DMFT
Number of children
Mean DMFT
95% CI
1960 Boys Girls
303 203
3.45 3.55
3.35-3.55 3.42-3.68
57 54
1988 Boys Girls
59 52
2.03 2.42
1.64-2.43 1.99-2.85
87 73
%
Table 4. Treatment Index (TI) for permanent first molars of 12-year-old children in 1960 and 1988 Numberof children
D/DMF
M/DMF
96
%
F/DMF %
FC/DMF %
TI
1960 Boys Girls
303 203
45.2 42.1
23.3 30-7
26.0 22-8
5.4 4.4
37.4 36.0
1988 Boys Girls
59 52
15.8 15.9
14.2 13.5
57.5
50.8
12.5 19.8
70-6 68-5
girls' maxillary first molars had been attacked. The corresponding figures in 1988 were 56% and 6 1%. Similar changes were recorded for the mandibular first molar. Whereas every type of tooth had been affected by caries in 1960, several had not suffered in 1988; in the boys these were the canines, mandibular premolars and mandibular incisors and, in the girls, the canines and mandibular lateral incisors.
Discussion In order to make a true comparison of dental
health of 12-year-oldsin Salford in 1960 and 1988 the methods of examination should ideally have been the same. Nevertheless it can be concluded that dental health has improved because large, statistically significant changes were detected and the differences in the diagnostic methods were small. In fact the magnitude of the change may have been underestimated because a visual-tactile examination has been shown.to produce slightly higher DMFS scores than a purely visual assessment [ 101. Because the percentage reduction in caries experience was greater in anterior than in posterior
90
J. G. Whittle & K. W. Davies
Table 5. Percentage of individual permanent teeth affected by canes in 12-year-old children in 1960 and 1988 Maxillary teeth Number of children
1
2
I960 Boys Girls
303 203
9 13
12 13
0
1988 Boys Girls
59 52
2 6
1 11
0 0
3
1
4
11 9
I
5
6
7
1
2
3
4
5
6
7
12 13
88 86
30 41
3 4
2
0 1
3 3
10
1
85 92
38 47
6 61
6 11
0 1
0 0
0 0
0 2
5
1
posterior teeth, the first molars contributed a greater proportion to the total DMFT score in 1988 than in 1960 (Table 3). The presence of fissure sealants was not recorded and, although an impression was gained that there were few in number, some preventive resin restorations may have been present. Thus, caries in first molars in 1988 may have made up a greater proportion of the total DMFT than was recorded. Use of the Treatment Index was first advocated in 1961, yet it has never won universal acclaim, and there is now a feeling that indices should reflect the role of primary prevention rather than treatment [ 1 11. The TI was therefore less relevant in 1988 than in 1960 but its use has provided an appreciation of how dental services have coped with caries over the study period. The TI has a value of 33 when the M component accounts for the total DMFT score. Jackson considered that this level was equivalent to that of an efficient casualty service (although it might be argued that such a service would be expected to save some teeth). He felt that it was impossible to give an ideal optimum figure for the TI but thought that, theoretically, it should be possible to achieve a value of 80. The services in Salford were not even providing care at the casualty level in 1960 (Table 2). By 1988 there had been a great improvement but it is clear that more still needs to be done to reach the optimum level.
ResumB. Un Cnchantillon de 111 enfants AgCs de 12ans de Salford (Grande-Bretagne)a CtC examine en 1983 et les rksultats comparCs avec ceux d’une Ctude rCalisCe en 1960 chez des enfants iges de 12 ans de la mCme ville. Entre 1960 et 1988, la moyenne CAO est tombCe de 6.04 A 2-34 chez les garcons et de 6-54 a 3-40 chez les filles. Toutes les
Mandibular teeth
5
5
10
0 4 6 7 7 6 1 1 6
dents Ctaient atteintes par la carie en 1960mais en 1988 aucune canine et incisive latCrale inferieure n’ttait atteinte. En 1960, les premikres molaires permanentes contribuaient pour 57% chez les garcons et 54% chez les filles A l’indice CAO alors qu’en 1988 elles y contribuaient pour.
Zusammenfassung. In 1988 wurde eine Gruppe von 11 1; 12-jahrigen Kindern aus Salford untersucht. Die Befunde wurden verglichen mit dem Untersuch von 1960an gleichaltrigen Kindern der selben Stadt. Von 1960 bis 1988 fie1 der durchschnittliche DMFT-Index der Knaben von 6-04 auf 2-34. Der der Madchen von 6.54 auf 3-40. In 1960 waren noch alle m n e befallen. In 1988 keine der Eckzahne und der seitlichen unteren Schneidezahne. Die ersten Molaren machten 1960 noch 51% bei de Knaben und 54% bei den Madchen des gesammten DMFT aus. In 1988 waren es 87% resp. 73%. Der Jackson Behandlungsindex zeigte eine Erhohung der zahn-arztzlichen Leistungen von 29.5 zu 63-2bei den Knaben und von 27.8 zu 62.3 bei den Madchen. Resumen. Una muestra de 1 1 1niiios de 12 aiios de edad de Salford, Reino Unido, fue examinada en 1988 y 10shallazgos comparados con 10sobtenidos en un examen realizado en 1960 en niiios de 12 aiios de edad de la misma ciudad. Entre 1960 y 1988, la media DMFT de 10s niiios disminuy6 de 6.04 a 2-34 y en las hembras de 6.54 a 3-40. Todos 10s tipos de dientes fueron afectados por caries en 1960 mientras que en 1988ninguno de 10scaninos e incisivos laterales mandibulares fueron afectados. En 1960,los primeros molares permanentes contribuyeron a1 57% en 10s niiios y 54% en las niiias en el total de DMFT mientras que en 1988 contribuyeron al 87% en 10s niiios y 73% en las
Dental caries in children in Sarford niiias en el total de DMFT. El Indice de Tratamiento de Jackson mostro que 10s servicios odonto16gicos tuvieron mayor impacto en 1988; para 10s varones aument6 de 29.5 a 63.2 y para las hembras de 27-8 a 62.3
References Hargreaves JA. The problem of dental caries in child dental health. British Dental Journal 1964; 116 386-390. Jackson D. An index for assessing the efficacy of dental treatment in the control of dental canes. Dental Practitioner 1961; 11: 226-229. Whittle JG, Mackie IC, Sarll DW. Changes in the dental health of Salford secondary school children over six years. British Dental Journal 1983; 155 199-202. Todd JE, Dodd T. Children’s dental health in the United Kingdom 1983. London: HMSO, 1985. Palmer JD, Anderson RJ, Downer MC. Guidelines for
91
prevalence studies of dental canes. Community Dental Health 1984; 1: 55-61. 6 Jackson D. The clinical diagnosis of dental caries. British Dental Journal 1950; 88: 207-2 13. 7 Kay EJ, Watts A, Patterson RC,Blinkhorn AS. Preliminary investigationsinto the validity of dentists’ decisions to restore occlusal surfaces of permanent teeth. Community Dentistry and Oral Epidemiology 1988; 1 6 91-94. 8 Downer MC, Teagle FA, Whittle JG. Field testing of an information system for planning and evaluating dental services. Community Dentistry and Oral Epidemiology 1979; 7: 11-16.
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