Description | Specific Indicators | Corresponding Mandatory Objectives | Corresponding National Indicators | Data Sources |  Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Cross-References to Other Sections | References  
 

Description

• The proportion of children with dental treatment needs.

Keywords

Dental, teeth, child, decay, cavities, caries, DIS, oral health, treatment, CINOT, topical fluorides, fissure sealants, urgent, Mandator

Specific Indicators

• Percent of children with urgent dental needs

• Percent of children with decay and/or urgent dental needs

• Percent of children eligible for CINOT

• Percent of children eligible for topical fluorides

• Percent of children eligible for fissure sealants

Corresponding Mandatory Objectives

http://www.health.gov.on.ca/english/providers/pub/pubhealth/manprog/manprog.html

• To reduce the prevalence of dental diseases in children and youth.

Corresponding National Indicators

• None

Data Sources (see Resources: Data Sources)

Numerator & Denominator: Ontario Dental Indices Survey (Dental Health Data)
Original source: Public Health Unit
Distributed by: Public Health Unit
Suggested citation (see Data Citation Notes):
Dental Indices Survey [years], [Public Health Unit], Extracted: [date]

Numerator & Denominator: Oral Health Screening (Dental Health Data)
Original source: Public Health Unit
Distributed by: Public Health Unit
Suggested citation (see Data Citation Notes):
Oral Health Screening [years], [Public Health Unit], Extracted: [date]

Numerator & Denominator: Children In Need Of Treatment (CINOT) (Dental Health Data)
Original source: Public Health Unit
Distributed by: Public Health Unit
Suggested citation (see Data Citation Notes):
Children In Need Of Treatment (CINOT) Database [years], Extracted: [date]

Survey Questions

• None

Analysis Check List

• Determine what sampling methodology was used within a health unit before making comparisons of the DIS over time or with other health units.

Method of Calculation 

 Percent of children with urgent dental needs:

 Percent of children with decay and/or urgent dental needs:

 Percent of children eligible for CINOT:

 Percent of children eligible for topical fluorides:

 Percent of children eligible for fissure sealants:

Basic Categories

• Geographic areas: public health unit.

Indicator Comments

• Data for this indicator come from three sources: DIS, Oral health screening and CINOT (see Dental Health data). 

• The Dental Indices Survey (DIS) Protocol of January 1, 1998¹ specifies the populations to receive the DIS and oral health screening:
  - the DIS is to be done for all school entrants (Junior Kindergarten and Senior Kindergarten) in every school annually;
  - oral health screening is to be done for all children in Grades 2, 4, 6 and 8 in high risk schools, and for children in Grades 2 and 8 in medium risk schools.

• Since some health units do not have sufficient resources to conduct the DIS and oral health screening as specified, they may survey or screen a sample of the children, and use a different methodology depending upon local resources. Alternatively, some health units may survey a larger group of children than specified by the protocol. As a result, the DIS is not comparable across health units. Comparisons within a health unit over time may be appropriate as long as the sampling methodology has remained consistent. 

• The CINOT Program provides treatment to children from birth to Grade 8 who have urgent dental health needs and whose parents declare financial hardship. Urgent needs include large lesions, infection, trauma, pathology, or irreversible periodontal disease. Children who are ineligible for CINOT because of age may be eligible for other programs. Families that do not require financial assistance must see that the dental work is done for their children and pay for the service themselves or through their dental insurance.

• Children come to the attention of the CINOT Program through the DIS, oral health screening, or through community referrals by dentists and other health professionals.

• Because the DIS is conducted for children at school entry (Junior Kindergarten and Senior Kindergarten) throughout the school year from September to June, children can range in age from 3 to 6 years. Similarly, children in a grade can vary in age.

• Urgent treatment needs are considered those meeting CINOT dental eligibility criteria. These children may or may not meet the other eligibility criteria of CINOT, namely age and financial need. Health units may vary in their definition of urgent treatment needs.

• “Decay and urgent need” captures those children who have some decay and/or urgent treatment needs. Decay is defined by a score of 02, 03 or 04 on the WHO Modified Index, whereby 02 is decayed pit and fissure, 03 is decayed smooth surface, and 04 is decayed both pit and fissure and smooth surface.⁶

• According to the protocol on Determining Eligibility for Preventive Oral Health Services provided through Ontario’s Board of Health²:
  topical fluoride application should be offered to children with one or more smooth-surface carious lesions, no dental insurance, and financial means to obtain this service privately;
  pit and fissure sealant application should be offered to children with no dental insurance, and financial means to obtain this service in accordance with tooth morphology (deep and narrow pits and fissures) and the patient’s risk for future dental caries as specified in the protocol.

• Professionally applied topical fluorides involves the topical application of fluoride to tooth surfaces to protect teeth from decay and reverse early lesions. A dental sealant is a plastic material used to cover the pits and fissures of teeth to act as a physical barrier to prevent caries from developing. Routine application of these procedures is unnecessary for most population but should be used for children at high caries risk.⁴

• The Mandatory Health Programs and Services Guidelines have the objective “to reduce the prevalence of dental diseases in children and youth”. This indicator is one measure of this objective, along with other dental indicators. However, information about youth is not available. Generally, information is available only for children on school entry in most health units.

• Oral disorders can have a significant impact on general health and well-being:
  - Dental decay is caused by bacterial infection. It is one of the most common disorders of childhood. It can cause pain, poor sleep and poor eating habits in children. Dental decay can be a contributing factor in “failure to thrive” whereby children have low weight and height for their age.⁵
  - Periodontal disease, a chronic infection caused by bacteria that accumulate in plaque, has been linked to various diverse health problems including pre-term low birth weight babies, heart disease, stroke, pneumonia, and chronic respiratory disease.⁵
  - Poor oral health can lead to poor nutrition and decreased quality of life due to pain, and chewing and speech problems.⁵

• There is a strong link between oral health and income. Low-income children and new immigrants are most likely to have poor oral health.⁵

Cross-References to Other Sections

• Visits to Dentist in Past Year (Section 9: Contacts with Health Professionals)
  

• Municipal Drinking Water Quality (Section 2B: Physical Environment) – fluoridation

References

1. Ministry of Health, Dental Indices Survey (DIS) Protocol, Child Health Program. January 1, 1998. 

2. Ministry of Health, Determining Eligibility for Preventive Oral Health Services provided through Ontario’s Board of Health Protocol, Child Health Program. January 1, 1998.

3. Burt BA, Elund SA. Dentistry, Dental Practice and the Community. Philadelphia: W.B. Saunders Company, 1999.

4. Hawkins RJ, Locker D. Evidence-based recommendations regarding the cost-effectiveness of pit and fissure sealants and professionally applied topical fluorides in Ontario’s public health dental programs. Community Dental Health Services Research Unit Quality Assurance Report No. 22.

5. Locker D, Matear D. Oral disorders systemic health, well-being and the quality of life: A summary of recent research evidence.

6. Ontario Ministry of Health. Dental Indices Software Program Manual. December 9, 1997.

7. Bennett S. Results from the 1993-94 Ontario Dental Health Indices Survey. PHERO 1996:355-358.

Date of Last Revision: November 10, 2004.