MLHU - Health Status Resource

Teeth-Brushing, Decay, and Oral/Facial Pain

Teeth-Brushing, Decay, and Oral/Facial Pain
Key Findings: 

Frequently brushing teeth in addition to regular visits to the dentist have been associated with better overall oral health.1-3 A high percentage of Middlesex-London residents report brushing their teeth at least twice daily.

Adults in Middlesex-London between the ages of 18 and 44 reported the highest percentages of brushing teeth at least twice daily, with females making up a greater proportion than males. Residents with a higher household income also report higher percentages of brushing two or more times daily, steadily going up in each of the five income brackets.

Over 16,000 children between the ages of 3−13 years in Middlesex-London schools were screened for oral health conditions in the 2018/19 school year. Of those, approximately 31% had at least one tooth that was decayed/missing/filled due to decay and 8% were identified with critical/urgent oral health needs.

In 2013/14, less than half of residents in Middlesex-London reported experiencing oral or facial pain in the past month, which is comparable to Ontario and the Peer Group. As with teeth brushing, residents in higher household income brackets reported less oral and facial pain.

Brushed teeth twice daily Reported oral or facial pain in past month
Tooth decay in children  

Brushed teeth twice daily

In 2013/14, 81.5% of residents in Middlesex-London over the age of 12 reported brushing their teeth at least twice daily. This is identical to the Ontario (81.5%) rate and near the rate reported in the Peer Group (80.5%) (not shown). Also consistent with provincial and Peer Group rates, more females than males in Middlesex-London reported brushing their teeth at least twice daily (Figure 8.2.1).

A higher proportion of Middlesex-London residents living in urban areas brushed their teeth two or more times daily (82.9%) in comparison to those in rural areas (70.9%). This was a statistically significant difference (not shown).

Adults in Middlesex-London between the ages of 18 and 44 reported a higher percentage of brushing teeth twice daily in comparison to those in other age categories. The differences between age groups were not significant different (not shown).

Those with the highest level of household income (Quintile 5) in Middlesex-London reported the highest percentages of brushing at least twice daily. This is also the case when education level increases. This trend was evident across Middlesex-London, Ontario, and the Peer Group (Figure 8.2.2). However, these differences were not statistically significant.

Interpretation

Frequently brushing your teeth can improve the overall health of your teeth and mouth by decreasing the risk of caries and teeth extraction due to caries.1-3 This improvement of overall oral health by frequently brushing is also often associated with an increase in dental visits and improved self-perceived oral health.1,2,4

The relationship between frequent brushing and overall oral health is evident in Middlesex-London, as a large percentage of residents reported brushing their teeth at least twice daily; accompanying the high percentage of frequent dentist visits and better self-perceived oral health compared to Ontario and the Peer Group.

Tooth decay in children

In the 2018/19 school year, a total of 16,149 children in junior kindergarten (JK), senior kindergarten (SK), grade 2, and grade 7 were screened among all schools in Middlesex-London (including both public and privately funded schools) by a dental hygienist for dental care needs.

The percentage of children with at least one decayed, missing, or filled (DMF) tooth varied across the grades of children screened. The highest percentage of children with some form of tooth decay was within the Grade 2 students, aged 6−7 years (45.3%). The lowest percentage was among JK students, with only about 22.2% having one or more DMF tooth (Figure 8.2.3). Similarly, the percentage of caries-free students was also the lowest among Grade 2 students and the highest among those in JK (Figure 8.2.4).

The percentage of children identified with critical or urgent oral health needs due to tooth decay decreased as children progressed grades. The highest percentage of children requiring critical or urgent care was observed among the JK students, aged 3−4 years (44.1%). The lowest percentage was among Grade 7 students, aged 12−13 years, with only about 11.5% requiring urgent oral health care (Figure 8.2.5).

Interpretation

The DMF indicator is a key oral health indicator for comparative purposes. According to the Canadian Dental Association, there are no other well-established and universally accepted indicators of overall oral health.3 Therefore, all public health units in Ontario are required to screen for and collect data on DMF teeth in children in grades JK, SK, and 2. However, the MLHU also screens and collects information on older children, in grade 7.

The rate of emergency department (ED) visits for non-traumatic oral health conditions was also the lowest among children and adolescents between the ages of 12 and 17. This highlights the impact of positive oral health practices early in development in reducing critical or urgent care needs, including pain and infections leading to an ED visit into adolescence and adulthood.

Reported oral or facial pain in the past month

Approximately half of residents in Middlesex-London (46.3%) in 2013/14 reported experiencing oral or facial pain in the past month. This is less than what is reported at both Provincial (51.3%) and Peer Group (51.9%) levels (Figure 8.2.6). This difference was not statistically significant.

Of these individuals, approximately half were females (50.8%) and only 41.6% were males, which is comparable to both Ontario and the Peer Group. However, none of these differences are statistically significant (not shown).

Children between the ages of 12 and 17 reported the highest percentages of oral and facial pain in the past month (54.2%), followed by those aged 45-64 (51.9%) (Figure 8.2.7). The lowest percentage was observed among residents over the age of 65 (33.4%).

Middlesex-London residents in the highest household income quintile reported the lowest percentage of oral or facial pain (37.5%) and those in the lowest two household income quintiles reported the highest percentages pf pain (53.5−54.7%). These differences between household income quintiles were not statistically significant.

No significant differences were seen by urban/rural, education level, or employment.

Interpretation
As children are still growing teeth between the ages 12 and 17 and commonly have issues with wisdom teeth from the age of 15 or 16 years, this may explain the higher percentage of oral or facial pain in this age group.

The lowest percentage being reported in residents 65+ (33.4%) raises some questions about how many seniors still have their natural teeth in Middlesex-London. Although this may not be the only consideration for low percentages of oral and facial pain (seniors may be on pain medication for other conditions), it is still important to note tooth loss. Not having natural teeth may lead to lower percentages of oral or facial pain. Therefore, whether or not seniors have any natural teeth is an important consideration for oral and overall health as losing teeth creates changes in eating patterns, nutrient uptake and weight as well as speech.3 There is not currently a method to accurately track this type of data. This is an area for consideration and development in the future.

Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability−Chronic Disease Prevention and Well-Being (page 28) 

Population Health Assessment and Surveillance Protocol, 2018

References:

1. Homes, R.D. Tooth brushing frequency and risk of new carious lesions. Evidence-Based Dentistry 2016 17; 98-9.

2. Canadian Dental Association [Internet]. Ottawa (ON): [2019] How not to see your dentist (more than necessary); [cited 2010 Oct 22]. Available from: https://www.cda-adc.ca/en/oral_health/talk/dentist.asp

3. Canadian Dental Association [Internet]. Ottawa (ON): [2017 Mar] The state of oral health in Canada; [cited 2019 Oct 10]. Available from: https://www.cda-adc.ca/stateoforalhealth/

4. Palma, Patricia & AA, Ibrahim & C, Bambaei & Tessma, Mesfin. (2016). Is there Association between Self-reported Dental visits, Tooth Brushing, Fluoride use and Perceived Oral Health Status?.Journal of Oral Hygiene & Health. 04. 10.4172/2332-0702.1000206

Last modified on: November 19, 2019

Jargon Explained: 

“DMF”
This stands for any tooth a child has that is decayed, missing, or filled due to decay. This is counted by both total children with any DMF (DMF≥1) as well as the exact number of teeth among children screened that was DMF due to decay.
“Caries free”
Children with no cavities or sign of decay are considered to be caries free.
Oral and facial pain
Oral or facial pain includes any pain or discomfort in the teeth or gums.