[Leica] NHANES Dental Caries Snapshot

[pswango at att.net (Phil Swango)]

Larry -- I see your point but I think your recommendation is too bold.  I
did the examiner training for the two earlier NHANES surveys and also the
NIDR studies of dental caries of school children conducted in the 1980s.
In the latter, as an example, the F component accounted for around 80% of
caries diagnoses by the examiners.  Granted, this number included many
(unknown) instances of unnecessary fillings, but completely ignoring it
would skew the prevalence estimates to the point of being essentially
meaningless.  It would also skew the data by demographics, since
populations with good access to care would likely have more F surfaces than
those who lacked access.

There are also problems with the D and M components.  One young examiner I
trained found 14 D surfaces in a subject in whom the reference examiner
(me) found only 2, and many M teeth are missing for reasons other than
caries.  These issues have been discussed at length by those of us who did
the field exams and/or calibrated the examiners.

There's no question that the F component is a source of some false
positives, but ignoring it completely would introduce a huge source of
false negatives.  However, I do think the issue should be discussed in
reports of findings.





Larry Burnett wrote:

As I remember the discussion which included authors from the study, led to
the realization that DMF included all the fillings that were medically
unnecessary.  That little "glitch" was actually hundreds of millions of
dollars of overtreatment which made the caries incidence look much worse
than reality.  As a matter of fact. Those involved in the study agreed that
DMF for those purposes should list decayed and missing and drop the filled
from the criteria.  Of course, that was the end of it.  Do you remember
that, and are you still on it?



-- 
Phil Swango
307 Aliso Dr SE
Albuquerque, NM 87108
505-262-4085