van Dommelen Paula, Schuller Annemarie A
Department of Child Health, TNO, Leiden, The Netherlands.
Center for Dentistry and Oral Hygiene in Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Community Dent Oral Epidemiol. 2016 Oct;44(5):485-92. doi: 10.1111/cdoe.12238. Epub 2016 May 11.
Untreated dental caries is the most prevalent medical condition worldwide, with considerable variations in prevalence between regions and countries. The care index (CI) and the restorative index (RI) are generally used to make comparisons between and within countries of levels of care delivered. However, several methodological challenges can be identified that limit the interpretation and comparison of these indices. The objective of this manuscript was to evaluate these challenges and to provide solutions.
Five challenges were identified: (i) the comparability of CI and RI, (ii) the use of multiple definitions of CI and RI, (iii) CI and RI measured for surfaces or teeth, (iv) the skewness of F/D(M)F (restored teeth or surfaces as a fraction of the total number of decayed, (missing), and filled teeth or surfaces), and (v) the relationship between CI, RI and D(M)F. Time-series data were obtained - for people aged 25-44 years with low socioeconomic status - from four cross-sectional studies performed in 1995, 2002, 2007 and 2013 in the Netherlands, and those data were subjected to descriptive analyses.
The analyses showed that the choice of index and definition had a major impact on the results, which varied in terms of absolute size and trends. Moreover, CI and RI are expressed as mean scores, but the distributions of F/DMF and F/DF were highly skewed. CI and RI may therefore mask groups of individuals who still need care. The proportion of individuals receiving most restorative care was much higher in the group with low levels of caries than in the groups with more caries. This implies that, when the need for care decreases over time, the restorative care indices can be expected to increase, even though there may be no improvement in the amount of care delivered.
We argue that epidemiological studies of oral health in the future should clarify the definitions used to describe the care delivered and investigate subgroups of F/DMF or F/DF in categories based on the extent of caries. These figures could be used to monitor changes in treatment provision and to highlight inequalities in the provision of care.
未经治疗的龋齿是全球最普遍的健康问题，不同地区和国家的患病率存在显著差异。护理指数（CI）和修复指数（RI）通常用于比较不同国家之间以及国家内部所提供的护理水平。然而，存在一些方法学上的挑战限制了这些指数的解读和比较。本文的目的是评估这些挑战并提供解决方案。
确定了五个挑战：（i）CI和RI的可比性，（ii）CI和RI的多种定义的使用，（iii）针对表面或牙齿测量的CI和RI，（iv）F/D（M）F（修复的牙齿或表面占龋坏、（缺失）和填充牙齿或表面总数的比例）的偏态分布，以及（v）CI、RI与D（M）F之间的关系。获取了1995年、2002年、2007年和2013年在荷兰进行的四项横断面研究中25至44岁社会经济地位较低人群的时间序列数据，并对这些数据进行描述性分析。
分析表明，指数和定义的选择对结果有重大影响，结果在绝对大小和趋势方面存在差异。此外，CI和RI以平均分数表示，但F/DMF和F/DF的分布高度偏态。因此，CI和RI可能掩盖了仍需护理的个体群体。龋齿水平较低的组中接受最多修复护理的个体比例远高于龋齿较多的组。这意味着，随着时间的推移护理需求减少时，即使所提供的护理量没有改善，修复护理指数也有望增加。
我们认为，未来口腔健康的流行病学研究应明确用于描述所提供护理的定义，并根据龋齿程度对F/DMF或F/DF类别中的亚组进行调查。这些数据可用于监测治疗提供情况的变化，并突出护理提供方面的不平等。
