The Association Between Oral Health Overall Systemic Health and Age Using DMFT Scores

ISSN: 2374-9075 (online)
Open Access Research Article
Journal of Oral Science and Health
The Association Between Oral Health, Overall Systemic Health

and Age Using DMFT Scores
Julie Kazimiroff,1 Biana Gotlibovsky,1 Sarah Bulger,1 Rohini Dhar,1 Glenda Rodriguez Aguiar,1
Galina Umanski,1 Kenneth Kurtz,1,2 Paul Meissner,1 and Katherine Freeman1
Montefiore Medical Center, The University Hospital of the Albert Einstein College of Medicine, Bronx, NY, USA
New York University College of Dentistry, USA
*Corresponding author:
Julie Kazimiroff
Montefiore Medical Center
The University Hospital of the Albert
Einstein College of Medicine
United States
E-mail: jkazimir@montefiore.org
Received: 12 Sep 2014
Accepted: 05 Feb 2015
Published: 07 Feb 2015
This article is distributed under
the terms of the Creative Commons
Attribution License, which permits
unrestricted use and redistribution
provided that the original author and
source are credited.
Competing interests: The authors
declare that no competing interests
exist.
Access This Article
Abstract
Background: Although Decayed-Missing-Filled-Teeth and/or Surfaces (DMFT/S) scores provide measures to assess caries risk and oral health, it is
age dependent. This report presents a simplified DMFT/S scoring system to
provide a snapshot of caries and dental care experience independent of age.
Presently, DMFT/S scores are not routinely used in caries risk assessment,
and patient risk stratification because the calculation process is cumbersome.
Therefore, a modified, practical DMFT/S tool is needed to measure caries status and the association between oral health and systemic health in individual
patients, dental practices or populations.
Objective: To assess the use of modified DMFT/S scores as a measurement
of oral health status, accounting for age and immune disorders.
Methods: Group 1: Healthy young adults (dentists) (N: 16); Group 2: Pediatric
dental patients 8 months to 35 months of age (N: 317); Group 3: Children and
adult patients requiring complex prosthodontic rehabilitation (N: 206). Group
4: Adult patients living with Human Immunodeficiency Virus /Autoimmune Deficiency Syndrome (N: 55) DMFT/S scores were measured from chart review
and dental radiographs. Descriptive statistics are presented for age, DMFT/S
by Group; multiple regression models determined differences in DMFT/S
among groups accounting for age.
Results: Overall, DMF scores increased with age (p< .0001). Each of the two
medically treated groups differed with regard to DMFT from the healthy adult
Group (p< .0001), and prosthodontics treated adults were significantly different from HIV treated adults accounting for age (p <. 0001).
Conclusion: An algorithm with standardized conventions that are applied in an
electronic dental record could have value for measuring the associations be-
Cite as: Kazimiroff J, Gotlibovky B, Bulger S, et al. The Association Between Oral Health, Overall Systemic Health and Age Using DMFT Scores. J
Oral Sci Health. 2015;2(1):1-16.
J Oral Sci Health. 2015 02 01/ 2374-9075: SS0005
01 of 16
www.sciencescript.org
Kazimiroff J et al
tween oral health and total or systemic health as well as quality improvement in dental care. Further studies with
increased sample sizes are required to demonstrate associations and identify predisposition to caries for targeting
interventions using this scoring system.
Background
We hypothesized that there was an association between oral health and overall health. In order to show the association, we present the use of the Decayed Missing and Filled Teeth and Surface (DMFT/S) ratio as an oral
health indicator. However, the DMF scores are not often applied in dental practice. The scores have traditionally
been used in public health and by dental research settings. To date, most commercially available dental software
programs for office practices do not calculate DMF scores.
We measured DMFT/S scores for four groups, children 9 months to 36 months of age, adults living with HIV/
AIDS; children and adults undergoing complex prosthodontic rehabilitation; and healthy young adult dentists. DMFT/S is a ratio of decayed (D), missing (M), and filled (F) teeth (T) or surfaces (S) per a standard number of
teeth or surfaces that provides a means for comparing dental health between individuals.[1] The purpose of this
study was to describe DMFT/S scores in each of the four distinct groups, and determine differences among the
groups accounting for age.
Dental caries is a major public health problem in most industrialized countries, affecting 60-90% of school children and the vast majority of adults.[2] Studies have reported that dental caries remains one of most common
conditions that affect children in the United States and worldwide. In the United States where dental caries had
been on the decline, presently there is resurgence. Dental caries experience in primary teeth for children aged
2-4 years increased 33.3% from 18% in 1988-94 to 24% in1999-2004, moving further away from the Healthy
People 2010 target of 11%.[3]
The associations of oral health to changes in systemic health have been difficult to quantify. Although it would
seem obvious that caries, gingivitis and periodontitis could provide an avenue for further disease in an immune
compromised person, some published studies have found that there is an ambiguous relationship between Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency (AIDS) and caries incidence. HIV/AIDS has
a strong correlation with other oral diseases not normally found in the general population, and in resource-limited areas these diseases, such as oral candidiasis, Kaposi sarcoma, and oral hairy leukoplakia can be used
as markers for AIDS diagnosis and progression.[4-7] One study did show an association between childhood oral
diseases including caries and compromised health. In children with HIV observed from 2003-2009, investigators
found a significant decrease in oral disease when children were receiving anti-retroviral medications.[8] Several
researchers have attempted to correlate standard dental DMFT and DMFS scores with HIV patient immune status,
HIV progression and mortality.[4,9] However, an association between health status and dental caries using DMFT
and/or DMFS scores is not often reported in the literature, and furthermore it is not routinely used in caries risk
assessment.
In a study designed to compare standard dental care with enhanced dental care in adults infected with HIV, Brown
et al.[4] evaluated gingivitis, oral pain, and used DMFS to measure active decay. They found that while enhanced
care, bimonthly protective treatment and twice-daily chlorhexidine rinses, reduced gingivitis compared to standard
care, there was equal improvement in DMFS scores in standard and enhanced treatments. The group was unable
to show any impact of improved dental health on immune status or disease progression, and theorized that this
was due to the use of retroviral therapies.[4] A study in India examined DMFT scores in HIV-infected children who
were categorized into mild, severe, and advanced disease based on their CD4 counts, and found that in general
02 of 16
Kazimiroff J et al
the children had a high rate of tooth decay, and that the prevalence was even higher in the advanced CD4 group.
[9]
In another study, primary dentition caries status in HIV-infected children was reported to beconsiderably greater
than that for the US pediatric population, and increases with decreasing CD4 percentage and moderate to severe
immune suppression.[10]
Dental caries studies of people without HIV/AIDS have attempted to demonstrate that improved oral health can
lead to improved physical and mental health. Malek et al.[11] conducted a longitudinal study on 6 year-old children
in which DMFT was recorded in deciduous teeth; also recorded were height, weight, with body mass index (BMI)
derived before and 6 months after removal of carious teeth. They found during this period, children gained weight
and increased BMI, and those children with the lowest initial weights had the most significant gains. Improved
oral health has long been associated with improved mental health and improved quality of life.[4,5,12] Quality of life
can improve overall health. For HIV-infected people, improvement in oral health has the potential to reduce social
stigma.[6] Some Investigators have looked at the association of dental caries and age.[13] However, oral health
and the ability to masticate should have a notable impact. Therefore, the relationship of age, oral health, ability
to masticate and overall systemic health could be used in an enhanced risk assessment algorithm. Overall, these
factors should be used to enhance DMFT/S scores.
The measurement of oral health indicators and its association with overall systemic health is an area of further
study. Hence, there is a need for a simplified validated tool to designate individuals oral health status that account
for age, function and overall systemic health.[9,10]
In this study, we conducted a longitudinal study of children ages 9 months through 3 years of age, HIV-infected
people, and children (12 years) and older patients undergoing complex prosthodontic rehabilitation. The study
used retrospective data collected from chart review and radiographs.
The objective of this study is to use a practical DMFT/S score as a measurement for oral health status to determine differences among groups categorized by age and health.
Methods
This study includes four groups. Healthy young adults who are dentists (N=16, age: 26 - 33 years, mean/median
27.8/27, standard deviation (SD) 1.9) served to establish a baseline reference for comparison (Table. 01). The
three other groups include young pediatric dental patients (N= 317, age: 8 months - 35 months, mean/median:
18.1/18 months, SD 7), patients undergoing complex prosthodontics rehabilitation (N=206, age: 12 - 101 years,
mean/median 57.2/60, SD 17.8) and patients with complex comorbidity, i.e.,people living with HIV/AIDS (PLWHA) (N=55, age: 24 - 67 years, mean/median 47.5/48, SD 9.7) (Table. 02, 03 and 04). In addition to HIV/
AIDS, the patients in this group all have other complex medical comorbidities. The demographics were derived
from the electronic medical record using Clinical Looking Glass, a proprietary electronic data mining software
program. Socioeconomic Status (SES) was calculated using an algorithm derived by Clinical Looking Glass that
is based on six variables: median household income; median value of housing units; the percentage of households receiving interest, dividend, or net rental income; education (the percentage of adults 25 years of age or
older who had completed high school and the percentage of adults 25 years of age or older who had completed
college); and occupation (the percentage of employed persons 16 years of age or older in executive, managerial,
or professional specialty occupations).[14,15]
Herein, we modified an oral health index most commonly used in pediatric dentistry. This scoring system can be
measured from the electronic dental record to use as one indicator for an individuals oral health status or caries
risk assessment based on the DMFT/S.
03 of 16
Kazimiroff J et al

mean/median
Age, months
Std. Dev.
mean/median
26
SES
Std. Dev.
Female
Hispanic
*
*
Gender
Male
N/A
33
min
max
27.8/27
1.9
min
max
*
8 (50%)
8 (50%)
Race/Ethnicity
Black not Hispanic
6 (37.5%)
4 (25%)
White not Hispanic
4 (25%)
Multiracial not Hispanic
Asian, Alaskan, Hawaiian, Native American Not Hisp.

N/A
Total
2 (12.5%)
0
16
Table. 01 Demographics for 16 adults Control Healthy Dentists
*equal or same SES based on income above Federal Poverty Level (FPL), same salary, housing conditions, and education as listed previously.[14]
mean/median
Age, months
Std. Dev.
min
max
mean/median
18.1/18
8
SES
Std. Dev.
35
-3.1/-2.5
2.5
min
-8.6
04 of 16
Kazimiroff J et al

max
Female
Gender
Male
N/A
Hispanic
2.2
148 (46.7%)
147 (46.4%)
Race/Ethnicity
Black not Hispanic
22 (6.9%)
131 (41.3%)
67 (21.1%)
White not Hispanic
10 (3.2%)

N/A
Total
60 (18.9%)
16 (5.1%)
33 (10.4%)
317
Table. 02 Demographics for 317 Pediatric Dental Patients ( 8 months through 35 months old)
mean/median
Age, months
Std. Dev.
17.8
min
max
mean/median
12
SES
Std. Dev.
Female
Hispanic
-1.1/-0.4
-8.6
Gender
Male
N/A
101
min
max
57.2/60
3.6
122 (59.2%)
79 (38.3%)
Race/Ethnicity
Black not Hispanic
5 (2.4%)
31 (15%)
30 (14.6%)
White not Hispanic
78 (37.9%)
6 (2.9%)
6 (2.9%)
05 of 16
Kazimiroff J et al

N/A
55 (26.7%)
Total
206
Table. 03 Demographics for 206 Patients Undergoing Complex Prosthodontic Rehabilitation
mean/median
Age, months
Std. Dev.
9,7
min
max
mean/median
24
SES
Std. Dev.
Female
Hispanic
-3.8/-3.6
-8.3
Gender
Male
N/A
67
2.7
min
max
47.5/48
2.2
26 (47.3%)
29 (52.7%)
Race/Ethnicity
Black not Hispanic
23 (41.8%)
29 (52.7%)
White not Hispanic
2 (3.6%)

N/A
Total
1 (1.8%)
0
0
55
Table. 04 Demographics for 55 HIV+ adults living with HIV/AIDS

The indicators of oral health include caries experience as well as management of dental caries including fillings
and tooth loss or dental experience. One method of measuring dental caries experience in a person is to examine
and count the number of decayed (D), missing (M), filled (F) teeth (T) and or surfaces (S), designated as DMFT
or DMFS, respectively. In order to obtain a DMFT score for the patient, three distinct values must be determined:
the number of teeth with fillings or crowns, the number of teeth with carious lesions, and the number of missing
teeth. Ratio score of 0 would indicate all 32 teeth are intact whereas the ratio score of 1 indicates that all teeth
found in an individual patient have dental work done and/or are missing or a combination involving all 32 teeth.
The DMFT score can range from 0-64 with a maximum of 64 in the case that no teeth are missing (0) and all
32 teeth are both decayed and filled.
06 of 16
Kazimiroff J et al
The DMFS scores provide more detailed information about the patients oral health. The DMFS score can range
between 0-160. In our modification, we assume that each tooth has 5 surfaces, equaling 160 surfaces for a full
dentition. For a patient with 6 decayed surfaces, 35 other surfaces either filled or included in a crown, and 4 teeth
that are missing, their DMFS score is 45. In this case, 89 surfaces are intact (Table. 05). The DMFS/S ratio
(ratio S) will equal 45/160, and like ratio T, the ratio S ranges from 0 to 1. With higher ratio T or S, the dental
patient is more likely to experience or manifest more extensive dental problems significant of poor oral health.
Dental health professionals chart dental caries by surfaces that require restoration. When charting 5 surfaces,
in effect, this describes the condition of each tooth. When we measure DMFS, it provides a more detailed representation of the dental conditions and caries experience of the patient as described above. Hence, DMFS will
give a more informative result of caries experience than the DMFT score, alone.However, DMFT is more easily
calculated from a dental charting perspective (Table. 05). It is more accurate to measure. For DMFS, the caries/
filled interpretation of each surface is much more subjective depending on the available radiographs and accuracy
of recorded hard-tissue charting. Because of the subjective nature of interpretation of caries and filled surfaces of
each tooth, it is more difficult and labor intensive to calculate and may be less accurate depending on calibration
of operators conducting the assessment.
Total Surfaces
160
Filled or with crowns
-35
Decays
-6
4 Missing teeth x 5 surfaces
-20
Total DMFT
89
Table. 05 Example of how to calculate the DMFT score

The pediatric scores are designed with lower case, DMFT/DMFS, and are scored based on a modification from
E. Lo.[16] Unlike in adult DMF scores, the score in children accounts for 20 teeth instead of 32. According to Lo,
the anterior teeth are only accounted for 4 surfaces and the posterior teeth for 5 surfaces. In our modification, we
have taken into consideration 5 surfaces for all teeth. This modification and the problem of counting the number
of surfaces that are used in a DMF score is discussed in depth by Broadbent et al.[17]
To evaluate the variability between the operators, DMF scores were performed by calibrated operators. We had 30
operators read the same set of radiographs and provide individualized DMFT and S scores for comparison. These
scores reported in this study were derived from radiographic interpretation at chart review, only. No additional
radiographs were taken for the purpose of this study. The project received Institutional Review Board approval as
part of an ongoing study on the biomineralization of teeth and caries risk.
Further clarification for how special dental problems are counted includes the following modifications:
1. Endodontically treated teeth with filled root canals were counted as follows:

i.
Root canal with crown: 1 filled tooth, 5 filled surfaces

ii.
Root canal with filling: 1 filled tooth, number (#) of filled surface

iii.
Root canal with decayed retained root: 1 decay, 5 decayed surfaces
2. Retained deciduous teeth (baby teeth) in the adult dentition were counted as follows:

i.
Missing adult teeth, note made on data sheet for these patients.
3. Supernumerary teeth:

i.
Designated as a negative integer, -1, for missing teeth.
07 of 16
Kazimiroff J et al
4. Impacted teeth were counted as present adult teeth with a note made on the data sheet for these patients.
Exclusions: DMFT/S for adult and pediatric dentitions out of different maximum values (adult: 64, 360 and pediatric: 40, 200); Mixed dentition patients were excluded.
5. Not all clinic patients had bite wing radiographs which we acknowledge are the standard radiographic view for
caries interpretation. Bitewing radiographs were not consistently available. Therefore, there were limitations on
caries interpretation from using a panoramic dental radiograph for counting decay on many of these cases. However, part of the usefulness of the modification that we present includes that a range or quartile can be established
with this retrospective scoring system that is useful for caries risk assessments.
The sample sizes were based on convenience/availability from patients seen at the clinic from 2012 through
2013. The groups were selected based on an Institutional Review Board (IRB) approved dental caries and biomineralization protocol.The healthy young adults showed little age variation and since they are dentists brought
with them a knowledge of oral health and access to care that could be considered a paradigm. Therefore, we
believe that the healthy young adults can serve as a comparison group.
Descriptive statistics are presented as means and standard deviations, and medians and ranges. Multiple linear
regression analysis was used to determine differences among groups with regard to DMFT/S accounting for age;
all interaction terms were assessed and variables in the final model were derived using a monitored backwards
stepwise procedure. Variables in the final models were those with resulting p-values < .05. All analyses were
performed using SAS Version 9.3, Cary NC.
Results
Sample Patient For Dmft/S Scoring From The Complex Comorbidity Group
Table. 06 The calibrated dentists were asked to score one individual using the same set of radiographs. No clinical
examination was done by these dentists. We used the panoramic radiograph below Figure. 01A from a sample
patient to measure variability of interpretation.
Group
Avg. DMFT SD
Prosthodontic Patients
23.20 9.14
Avg. DMFT/T SD 0.73 0.29

Avg. DMFS SD
101.17 50.44
HIV + Patients
Pediatric Patients
Healthy Dentists
0.61 0.29
0.02 0.05
0.23 0.15
19.44 9.11
0.32 0.95
77.13 50.96
Avg. DMFS/S SD 0.63 0.32
0.67 2.35
0.48 0.31
0.01 0.02
7.50 4.92
21.06 11.67
0.18 0.10
Table. 06 Average DMFT or S scores, ratios and standard deviations

The graphs in Figure. 01B below show the subjective bias during interpretation of one sample patient panoramic
dental radiograph used during training, scoring and calibration of operators: standard deviation (SD) = 4.2 for
DMFT but SD = 23 for DMFS.
There is noticeable discrepancy in the DMFS scores based on interpretations done by multiple calibrated operators
(dentists, N = 29). We saw less variation when using DMFT scores when comparing the variability among multiple
calibrated operators. Figure. 01C.
We propose the following, as shown in Figure. 01B. Quartiles, designated in the graphs separate the oral health
interpretation into units of 16 for DMFT and by 40 for DMFS resulting in the following categories:
08 of 16
Kazimiroff J et al

Figure. 01A The radiograph used for the measurement of variability in interpretation of DMFT/S score is presented to
demonstrate the level of difficulty reading this film that was encountered by the dentists who scored the case.
Note: This person has poor systemic health is HIV positive and was 53 years of age at the time the radiograph was taken
Figure. 01B The graph above is for DMFS scores derived from the radiograph in Fig 1a. (Minimum (Min) = 67, Maximum (Max) = 150, SD = 23)
DMFT: 0-16 excellent to good; 17-32 fair to poor; 33-48 poor; 49-64 extremely poor.
DMFS: 0-40 excellent to good; 41-80 fair to poor; 81-120 poor; 121-160 extremely poor
A larger range was selected for the DMFS quartiles due to the larger SD = 23. Therefore, because of variability
observed in the DMFS, we report on the DMFT score in the following groups. Overall, using the DMFT score, age
was positively associated with DMFT (p > .05)
Healthy Young Adult Dentist Group
The DMFT / DMFS scores among healthy individuals (N: 16) were derived from healthy young dental residents
with no known medical comorbidities. The DMFT score ranges from 0-18 (Avg. = 8, SD = 5) the DMFS score
09 of 16
Kazimiroff J et al
ranges between 0-47 (Avg. = 2, SD = 12). The graphs below show that the DMFT score are mostly between the
range of 0 and 20 shows that is a strong correlation between oral health and health status. The young healthy
dentists DMFT scores fall within the quartile for excellent to good dentition or oral health indicator. However, there
is one dentist that had an outlier score of 18. The age range is so narrow, 26 to 33, that there is no correlation
with observed by age (R = 0.00).

Figure. 01C The graph above is for DMFT scores derived from the radiograph in Figure. 01A (Min = 27, Max = 48,
SD = 4.2)
Pediatric Dental Patient Group
DMFT scores for pediatric patients between the ages of 8 months to 35 months old, ranges between 0-5.
Limitation
This group includes children ranging between the ages of 8 month to 35 months which may cause us to over or
under estimate the caries score/ dental experience of the child because until the age of 6 the child only has 20
teeth. According to that the maximum DMFT score should be 20 and the DMFS score should be 100. The score is
reported In relation to the number of teeth present in the childs mouth and gives a more accurate representation of
the oral health by demonstrating dental caries and dental experience of the child. The graph shows the computed
score for this group have experienced dental caries by an early age.
Multivariate Analyses
The first multiple regression analysis involved the comparison between young healthy children and all other
groups with regard to DMFT; controlling for age, results indicated that DMFT scores for the Healthy Young Adult
(Dentists) group, the HIV+ group and the group with adults and children who received prosthodontics care were
significantly greater than those of young children (p <.02). In addition, patients treated with prosthodontics had
greater DMFT scores at younger ages and their rate of increase with age was less compared with other subjects.
For the second model that compared the Healthy Young Adult (Dentists) group with both the HIV+ group and the
group with adults and children who received prosthodontics care, DMFT scores were significantly greater in the
Healthy Young Adult (Dentists) group, controlling for age (p <.001). The last analysis compared DMFT scores
between the HIV+ group and the group with adults and children who received prosthodontics care, for HIV+ paCite as: Kazimiroff J, Gotlibovky B, Bulger S, et al. The Association Between Oral Health, Overall Systemic Health and Age Using DMFT Scores. J
10 of 16
Kazimiroff J et al
tients had generally lower DMFT scores except for those under 25 and those over 65 (p < .01). In all analyses,
older age was independently associated with increased DMFT (p < .0001). Table. 07 below resents results of
multivariate models.
Model : Do HIV, Prosthodontics, and Healthy
Young Adult Groups
differ from Health Children? R2= 0.81
Estimate
Standard Error
P-Value
Intercept
Age Squared*
0.08510
0.7847
Healthy Young Adults
0.00471
0.31129
3.73651
1.50582
0.0134
HIV +
Prosthodontics
0.00065
5.03019
<.0001
2.12252
16.51129
0.0181
0.87390
Interaction Prosth & Age2 -0.00289
<.0001
0.00068
Model: Do HIV and Prosthodontics groups differ from Healthy Adults? R2=0.31
<.0001
Intercept
6.07009
2.04372
0.0032
HIV +
-0.972749
3.70192
0.7929
Age Squared*
Interaction HIV+ & Age2
Prosthodontics
0.001849
0.00029
0.00290
<.0001
0.00100
10.52612
0.0040
2.26450
Model: Does the HIV Group differ from the Prosthodontics Group? R2=0.22
<.0001
Intercept
5.09734
3.14101
0.1059
Prosthodontics
11.49901
3.36893
0.0007
Age Squared
0.00474
0.00097
Interaction Prosth & Age2 -0.00290
<.0001
0.00102
0.0047
Table. 07 Statistical Models for Health Conditions, DMFT Scores and Age
Discussion
Herein we propose a modified a DMFT/S scoring system that can be used to measure point prevalence of caries
in a dental population. There are not many reports on DMFT or S in adult populations in the literature. Unlike other
systems,we used five surfaces for each tooth and counted third molars or wisdom teeth.[16,17] Other studies only
count for four surfaces for anterior, and disallow the incisal as a surface. Our simplified method can be used to
address the variability of patient dentition across age and health status. Even though the groups are of completely
different characteristics and background, we would expect their oral health to be different. Moreover, we are not
making any comparisons or association among the four . However, the scoring system could be used to separate
groups as distinct, which is what they are. In the future, we will be able to use this scoring system for analysis
within each group e.g. DMFT/S versus age of children or adults and look for an effect of comorbidity. Using this
system, patients in prosthodontic care had in general significantly greater DMFTs than other groups, followed by
11 of 16
Kazimiroff J et al
HIV+, then healthy young adults, with the lowest DMFTs found in children.
Sample Patient For DMF Scoring From The Complex Comorbidity Group
The standard deviation for the test radiograph suggests that the DMFS score is more prone to discrepancy or
inaccuracy when used during a radiographic review as shown in Figure. 01B. One possible explanation is that
the quality of the radiographs interfered with the dentists ability to make accurate diagnosis. The dentists did not
have access to a full series of periapical views or traditional bitewing views that are used for caries interpretation.
Another explanation is that the score is based on radiographic interpretation retrospectively without a clinical
examinations conducted during the interpretation. These include the limitations that can be ascribed to dental
radiographs in general.[18,19]
However, despite variability in the interpretation and limitation on the quality and type of radiographs, the range
that the DMFS scores approach stays within a quartile that could be used to represent the oral health status of
the patients dentition.
Limitations of this modified DMFT/S system include:
1. The can be radiographic interpretation error.
2. The etiology of tooth loss or reason for missing teeth is not accounted for.
Tooth loss causes can be caries, trauma, orthodontia, congenitally missing and periodontal tooth loss. Therefore,
the score may give a false interpretation that a tooth is lost due to decay and thereby affecting the interpretation
of oral health.
3. We cannot account for sealed teeth and veneers or crowns placed for aesthetic reasons.
4. There is no accountability for fractured teeth, attrition, erosion and abrasion facets.
5. The DMFT scoring system does not account for periodontal disease. Periodontal pocket depth charting should
be included in a total oral health assessment.
6. There is no accountability for fixed and removable complete and partial dentures or implants.
Subjects within groups were chosen based on convenience; this could introduce bias and lack of statistical power. In addition, there was no overlap in age between the young childrens group and other groups, and very little
among the older groups.
Healthy Young Adult (Dentist) Group
The healthy young dentist DMFT/S scores fall within the quartile for excellent to good dentition status. Therefore,
we establish the baseline upper and lower limits. There is one dentist that had a score of 47. Therefore, the quartile designation for oral health status does not apply (Figure. 02A).
Pediatric Dental Patient Group
Ideally, children should have no caries experience.[20] Therefore, the results presented in Figures. 02B, are troubling because they suggest that the pediatric group does have caries experience and at a very young age (8
months to 35 months). It should be noted that the children selected for the purposes of this study are from an
inner city, densely populated, lower socioeconomic community, possibly skewing the results because they are at
higher risk for dental caries (Figure. 02B).
Prosthodontic Patient Group
The DMFT score shows a dense clustering between of scores above 16 (second quartile).There are many cases
that represent edentulous and by chart review have complete dentures. There was correlation with age seen in
prosthodontic patients. It is expected because these are older patients who are under treatment for missing teeth
and previously had caries experiences (Figure. 02C).
12 of 16
Kazimiroff J et al
Figure. 02A The graph above is derived from the DMFT scores of young healthy dentists (N = 16) that should be the
paradigm of oral health.

Figure. 02B The graph shows a representation of the use and distribution of the DMFT score by age within the pediatric Group with the trend line showing a small negative association
Complex Comorbidities (HIV+) Group
Overall, prosthodontic and HIV+ group graphs when compared to those of the group comprising healthy young
dentists and the pediatric group show an increase in caries with age and medical comorbidities. The increase
in the DMFT/S scores supports our hypothesis that there is a correlation between age, oral health and overall
health. Beena et al,[9] reported on the relationship between high caries scores using DMF in children with HIV.
However, there are few if any caries studies in HIV+ adults using a scoring system. In the future, it would be of
value to compare PLWHA to healthy adults to establish relationship and conditions related to HIV treatment and
caries experience (Figure. 02D).

13 of 16
Kazimiroff J et al
Figure. 02C Prosthodontic Patient Group.
DMFT score within Prosthodontic patients by age shows a small positive correlation.DMFT for prosthodontic patients shows a dense clustering
between of scores above 16 (first quartile)
Figure. 02D Complex Comorbidities (HIV+) Group
DMFT score for HIV + people by age indicating a positive correlation
Among the primarily adult groups (prosthodontic and PLWHA) there is a small correlation (R= 0.18, with the
DMFT score by age, which is not seen in the pediatric group which shows less because of primary dentition teeth
are only in the mouth for 6 month to 6 years (average 5 years) years versus adults that hold teeth ideally for 100
years. This means that the adult has more chance to experience caries than the child.
Caries Risk and Etiology
Diet, personal oral hygiene, microbiome, fluoride supplementations, medications that induce xerostomia and/or
access to dental care are overwhelming and confounding factors that need to be considered.[21] Also, other clinical
information in addition to the DMFT/S scores such as quantification including periodontal examinations is needed
to determine the total oral health status of a person. In the future, a relative value score used with DMFT/S quartiles to assign oral health status may be used to demonstrate the change in trends of dental treatment such as esthetic dentistry, implants and orthodontics. The usefulness of dental caries scoring systems in quality improvement
14 of 16
Kazimiroff J et al
initiatives for dental care should be considered. In conjunction with this scoring system, the etiology of caries risk,
periodontal status and the relative value of functional rehabilitation with dental prostheses would provide a total
picture for an improved measuring system to demonstrate association of oral health and total health.
Conclusion
The hypothesis that DMFT/S scores should be lower with children and higher with age or decreased health status is supported by the data derived. Further study with increased sample size and multiple scoring by calibrated
operators is required to demonstrate precision and variation using this method to identify predisposition to caries
for targeting interventions. This system can be used for quick assessment of caries experience and risk with the
DMFT/S scoring for a patient, in a dental practice or community health of a population and thereby assist health
care planners and third-party payers with actuarial calculations.
References
1. Bodecker CF, Bodecker HW. A practical index of the varying susceptibility to dental caries in man. Dental
Cosmos. 1931;77:707-716.
2. Petersen PE. World Health Organization. Global Forum Update on Research for Health. Addressing neglected
health issues: Global research challenges for oral health. 2005;2:181-184.
3. U.S. Department of Health and Human Services. Healthy People 2010 Final Review. National Center for
Health Statistics.
4. Brown JB, Rosenstein D, Mullooly J, et al. Impact of Intensified Dental Care on Outcomes in Human Immunodeficiency Virus Infection. AIDS Patient Care STDS. 2002;16(10):479-486.
5. Coogan M, Greenspan J, Challacombe S. Oral Lesions in Infection with Human Immunodeficiency Virus. Bull
World Health Organ.2005;83(9):700-706.
6. Hodgson TA, Naidoo S, Chidzonga M, et al. Identification of Oral Health Care Needs in Children and Adults,
Management of Oral Diseases. Adv Dent Res. 2006;19(1):106-117.
7. Ranganathan K, Hemalatha R. Oral Lesions in HIV Infection in Developing Countries: an Overview. Adv Dent
Res 2006;19(1):63-68.
8. Yengopal V, Bhayat A, Coogan M. Pediatric Oral HIV Research in the Developing World. Adv Dent Res.
2011;23(1):61-66.
9. Beena JP. Prevalence of Dental Caries and Its Correlation with the Immunologic Profile in HIV-Infected Children on Antiviral Therapy. Eur J Paediatr Dent. 2011;12(2):87-90.
10. Hicks MJ, Flaitz CM, Carter AB, et al. Dental caries in HIV-infected children: a longitudinal study. Pediatr
Dent. 2000;22(5):359-364.
11. Malek Mohammadi T, Wright CM, Kay EJ. Childhood growth and dental caries. Community Dental Health
2009;26(1):38-42.
12. Coulter ID, Heslin K.C, Marcus M, et al. Associations of self-reported oral health with physical and mental
health in a nationally representative sample of HIV persons receiving medical care.Qual Life Res. 202;11:5770.
15 of 16
Kazimiroff J et al
13. Broadbent JM, Foster Page LA, Thomson WM, et al. Permanent dentition caries through the first half of life.
Br Dent J. 2013;215(7):E12.
14. Diez Roux AV, Merkin SS, Arnett D, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99-106.
15. Freeman K, Strauchler D, Miller TS. Impact of socioeconomic status on ionizing radiation exposure from medical imaging in children. J Am Coll Radiol. 2012;9(11):799-807.
16. Lo E. Caries Process and Prevention Strategies: Epidemiology. Crest Oral B 2012. http://www.dentalcare.
com/media/en-US/education/ce368/ce368.pdf. Accessed June 9, 2014.
17. Broadbent JM, Thomson WM. For debate: problems with the DMF index pertinent to dental caries data analysis.Community Dent Oral Epidemiol. 2005;33(6):400-409.
18. Webber RL. Dental radiology. Present limitations and future prospects. Int J Technol Assess Health Care.
1990;6(4):603-609.
19. Kantor ML. Longitudinal trends in the use of individualized radiographic examinations at dental schools in the
United States and Canada. J Dent Educ. 2006;70(2):160-168.
20. Moss SJ. Growing Up Cavity Free: A Parents Guide to Prevention. Quintessence Publishing Company. 1993.
21. Hunter PB. Risk factors in dental caries. Int Dent J 1988;38(4):211-217.
16 of 16

The Association Between Oral Health Overall Systemic Health and Age Using DMFT Scores

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

The Association Between Oral Health Overall Systemic Health and Age Using DMFT Scores

Diunggah oleh

Hak Cipta:

Format Tersedia

ISSN: 2374-9075 (online)

Open Access Research Article

Journal of Oral Science and Health