Note: this lecture includes what is mentioned in the lecture summarized by your group and the handouts

METHODS OF MEASURING ORAL DISEASES

There are so many oral diseases that we can measure and study, such as: dental caries, periodontal diseases, malocclusion, dental fluorosis, oral lesions, oral cancers .

How to measure oral diseases?

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1. Count 2. Proportion 3. Index Counts

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Count is the simplest form of measuring any disease In here we measure the disease counting the

number of cases with the disease of interest

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Simple counts of cases are most useful with unusual

conditions of low prevalence such as oral cancer

and AIDS and they become less useful as prevalence

increases Proportions
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A count can be turned into a proportion by adding a

denominator
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Proportion = numerator over denominator

Proportion enables us to determine the

prevalence of the disease

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Prevalence = The proportion of individuals in a

population who have a specific disease to the percentage of individuals in the same population who dont have that disease at a particular moment of

time
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Proportions do NOT include a time dimension

thats why they can determine prevalence BUT NOT incidence of the disease
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Proportion includes new cases with the disease

as well as longstanding cases

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For example: we conducted a research on 845 male

patients aged between 55 and 64 years old We found that only 22 males had prostate cancer at that given time

Count = counting the number of males having prostate

cancer among the 845 males studied = 22 males

Proportion = finding the percentage of males with

prostate cancer to the number of all males studied =

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22/845 = 2.6% = prevalence of prostate cancer at that given time in that given population
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Proportions can also be useful in expressing the

prevalence of caries among schoolchildren, the prevalence of total tooth loss in adults, or other
conditions whose occurrence is somewhere between

common and rare

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Rate = proportion that uses a standardized

denominator and includes a time dimension

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Rate enables us to determine the incidence of

the disease
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Incidence = is the proportion of individuals in a

population who WILL HAVE specific disease or condition relative to the whole population after a specific period of time
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For example: Infant mortality is defined as the

number of deaths of newborn infants within the first

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year of life time dimension per 1000 live births standardized denominator Rate = number of infants dying/number of births 1000/period of time 1 year, 2010 for example
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Rates have actually been little used in oral disease

measures, EXCEPT in caries incidence over a period of time in clinical trials and in annual rate of loss of periodontal attachment in longitudinal studies
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Proportions or index values are often mistakenly

referred to as rates in the literature

Indexes indices
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Index is used to weigh and quantify the Index = a graduated numerical scale having

epidemiological data collected

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upper and lower limits, with scores on the scale corresponding to specific criteria
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For example: the individual who suffers from caries in

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only 2 of 32 teeth clearly has a much lower intensity of

disease than does the person who has carious lesions in 16 of 32 teeth

Simple prevalence does NOT discriminate between

these two degrees of intensity, which is usually determined in oral epidemiology by use of an index
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Index scores can be expressed for an individual or for

populations and are used to quantify and compare disease conditions between individuals or groups
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In the literature, the word index is often used broadly

to mean any form of disease quantification,

including proportions and rates

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We encourage confining the index to the use of

scales
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There are several kinds of scales for measuring

the intensity of a condition: 1. 2. 3. Ordinal scale Nominal scale Interval or ration scale
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Nominal scale
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Nominal scale = is a scale that simply gives names

to different conditions

- Nominal scale is the lowest grade of scales and it is NOT strictly a scale at all
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For example: ,

Ordinal scale
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Ordinal scale = is a scale that lists conditions in

some order of severity without having any mathematical relation between the categories
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Ordinal scales permit the measurement of degrees of

difference, but not the specific amount of difference

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The majority of scales used in oral epidemiology

are ordinal scales

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For example:

We can classify oral hygiene of a particular patient as being excellent, very good, good, fair or poor In any participation, we might have first, second and

third ranks IQ test 70<100<130<160 and so that level of

intelligence

Interval or ratio scale

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Interval or ratio scale = is a scale in which the

numbers used in the measuring scale have a

mathematical relation to each other

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For example: if the number 1 is used to describe a

degree of gingivitis that meets certain criteria, then if the condition is graded 2 then it is considered to be

twice as bad, and if the condition is graded 3 then it is

considered to be three times as bad, and so on, until the upper limit of the scale is reached
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The difference between ratio and interval scales is that

a ratio scale has a true zero point such as

measures of height and weight and also Kelvin scale of temperature whereas an interval scale does NOT have a true zero point such as Fahrenheit and Celsius temperatures because 0 degrees does NOT mean absence of heat

Ideally, an index including its scoring criteria should possess the following properties: 1. Clarity, simplicity, and objectivity Clear = unambiguous = using this index you can tell
without doubt if the patient has the disease or not

Simple = the examiner is able to memorize the

criteria of the index and the index is reasonably easy to apply so that there is no time lost during field examinations

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Objective = using this index enables us to reach

goals DMF caries index is objective but

periodontal index is not 2. Validity

The index must measure what it is intended to measure, so it should correspond with clinical stages of the disease under study at each point and there should be no deviation from the actual records Examples will be given later of indexes that appeared valid when first developed but that appeared less so later when the natural history of the disease became understood better.

3. Reliability Reliability = reproducibility and consistency =

consistent on repetition = the ability of the same or different examiners to interpret and use the index in the same way The index should be able to measure consistently at different times and under a variety of conditions
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4. Quantifiability
The index should be able to undergo statistical analysis, so that the status of a group can be expressed by a distribution, mean, median, or other statistical measures.

5.

Sensitivity
The index should be able to detect reasonably small shifts, in either direction, in the condition

6. Acceptability
The use of the index should not be painful or demeaning to the subject There are other terms used in the literature to describe indexes, such as reversible and irreversible

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Irreversible index = index that measures cumulative

conditions that can NOT be reversed to a health state back again

For example:

Dental carious lesions that are cavitated Tooth loss itself Periodontitis is an irreversible inflammatory

restored or unrestored

condition
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Reversible index = index that measures conditions

that can return to a state of health again

For example:

Incipient carious lesions that are not Gingivitis is a reversible inflammatory

cavitated yet

condition

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A final general point about indexes is that just as there is

no perfect index, there is also no all-purpose index

that meets every need

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