CHAPTER 4. RESULTS
4.3 Analyses
4.4.1 Dental status
4.4.1.1 Relationship between dental status and care recipient characteristics
75 4.4 Oral epidemiological examinations
This section reports the frequency of oral conditions and its relationship with factors hypothesised to influence those conditions. Disease frequency is expressed using means or proportions (as appropriate) and their associated 95% CIs. Greatest emphasis is given to findings regarding caries experience, indexed using the mean DMFT per person, which is the primary outcome variable for this study. Accordingly, findings regarding the relationship between residential setting and DMFT are subject to additional stratified analyses that are not presented for other oral health indices that form secondary outcomes. At the end of the subsection for each oral condition, a summary table is provided using symbols that show if there is any significant difference between each variable category and its reference group.
Unless otherwise stated, references to "significant" differences signify a statistically significant finding, where the probability of type I error (P-value) is less than 0.05.
of communication, general health or care recipients’ need for help with self-care activities (Table 4.27).
The mean DMFT among care recipients in this population was 5.2 [95% CI = 4.5, 5.6].
Those at institutions had the highest mean DMFT of 8.6 [95% CI = 6.8, 10.4]. The prevalence and mean of DMFT was significantly higher among care recipients in institutions, the 35–44 years age-group and those with intellectual disability compared to those in community settings, the younger age-groups and those with cerebral palsy, respectively. The prevalence and mean DMFT did not vary between sexes, means of communication and general health or care recipients’ need for help with self-care activities (Table 4.27).
Table 4.27 Relationship between dental status and care recipient characteristics
Prevalence – % of people with: Mean DMFT D>0 M>0 F>0 DMFT>0 per person N % [95%CI] % [95%CI] % [95%CI] % [95%CI] Mean [95% CI]
All 267 16.9 [12.7, 21.7] 49.8 [43.6, 55.6] 57.1 [51.2, 63.0] 76.3 [71.0, 81.2] 5.2 [4.5, 5.6]
Residential setting
Family 130 20.0 [13.1, 26.9] 42.3 [33.8, 50.8] 53.8 [45.3, 62.4] 74.0[66.5, 81.6] 4.2 [3.2, 5.1]
Community housing 81 17.1 [8.9, 25.2] 46.9 [36.0, 57.8] 52.4 [41.6, 63.3] 69.1 [59.1, 79.2] 4.6 [3.5, 5.8]
Institution 56 10.7 [2.6, 18.8] 70.9 [58.9, 82.9] 71.4 [59.6, 83.3] 91.1 [83.6, 98.5] 8.6 [6.8,10.4]
Age
18–24 92 19.6 [11.5, 27.7] 41.3 [31.2, 51.4] 48.4 [38.2, 58.6] 71.0 [61.7, 80.2] 3.5 [2.6, 4.5]
25–34 81 18.5 [10.1, 27.0] 37.8 [27.3, 48.3] 46.3 [35.6, 57.1] 63.4 [53.0, 73.8] 3.6 [2.5, 4.7]
35–44 93 12.8 [6.0, 19.5] 68.8 [59.4, 78.2] 75.3 [66.5, 84.0] 92.6 [87.2, 97.9] 8.3 [6.9, 9.6]
Sex
Male 165 19.9 [13.8, 26.0] 46.4 [38.8, 54.0] 57.6 [50.0, 65.1] 76.5 [70.1, 83.0] 4.9 [4.1, 5.6]
Female 102 11.8 [5.5, 18.0] 55.9 [46.2, 65.5] 55.9 [46.2, 65.5] 75.5 [67.1, 83.8] 5.8 [4.5, 7.1]
Disabling condition
Autism 83 25.3 [16.0, 34.7] 47.0 [36.3, 57.7] 62.2 [51.7, 72.7] 81.9 [73.7, 90.2] 4.9 [3.8, 6.1]
Cerebral palsy 63 11.1 [3.4, 18.9] 33.3 [21.7, 45.0] 39.7 [27.6, 51.8] 60.3 [48.2, 72.4] 2.9 [1.9, 3.9]
Intellectual disability 90 16.7 [9.0, 24.4] 66.7 [56.9, 76.4] 61.5 [51.5, 71.5] 84.4 [77.0, 91.9] 7.2 [5.8, 8.6]
Other 31 6.5 [-2.2, 15.1] 41.9 [24.6, 59.3] 64.5 [47.7, 81.4] 71.0 [55.0, 87.0] 4.9 [2.9, 6.9]
(Spina bifida, quadriplegia, head injury) Communication
Verbally 122 20.5 [13.3, 27.7] 48.4 [39.5, 57.2] 65.9 [57.5, 74.2] 79.5 [72.4, 86.7] 5.6 [4.6, 6.7]
Non-verbally 61 14.8 [5.9, 23.7] 47.5 [35.0, 60.1] 52.5 [39.9, 65.0] 75.4 [64.6, 86.2] 5.1 [3.7, 6.5]
Little/no
effective communication 83 12.0 [5.1, 19.1] 53.6 [42.9, 64.2] 47.0 [36.3, 57.7] 72.3 [62.7, 81.9 ] 4.7 [3.4, 6.0]
General health
Ex-Very good 109 21.1 [13.4, 28.8] 48.6 [39.2, 58.0] 57.3 [48.0, 66.5] 80.7 [73.3, 88.1] 4.6 [3.7, 5.5]
Good 109 14.7 [8.0, 21.3] 50.5 [41.1, 59.9] 57.8 [48.5, 67.1] 74.3 [66.1, 82.5] 5.5 [4.4, 6.7]
Fair/poor 41 9.8 [0.7, 18.8] 48.8 [25.8, 52.6] 55.0 [39.6, 70.4] 72.5 [47.5, 77.5] 5.8 [3.6, 8.1]
Help needed
for self-care activities
Never/sometimes 77 23.4 [13.9, 32.8] 48.1 [36.9, 59.2] 75.0 [65.3, 84.7] 85.5 [77.6, 93.4] 5.4 [4.1, 6.7]
Always 190 14.2 [9.3, 19.2] 50.5 [43.4, 57.6] 50.0 [42.9, 57.1] 72.8 [62.0, 75.2] 5.2 [4.3, 6.0]
76
4.4.1.1.1 Summary of findings on dental status and care recipient characteristics
In these bivariate analyses, the prevalence of missing teeth, any caries experience (DMFT>0) and mean DMFT were significantly higher among the care recipients at institutions than those at family homes. The 35–44 age-group had a significantly higher prevalence of missing and filled teeth and caries experience and a higher mean DMFT than their younger counterparts.
Care recipients with intellectual disability had significantly more missing teeth, caries experience and a higher mean DMFT compared to those with cerebral palsy. Care recipients with autism also had a significantly higher caries experience compared to those with cerebral palsy. There was no significant association between dental status and sex, means of communication, general health or care recipients’ need for help with self-care activities.
Table 4.28 Relationship between dental status and care recipient characteristics
Prevalence – % of people with: Mean DMFT D>0 M>0 F>0 DMFT>0 per person Residential setting
Family (Ref)
Community housing ~ ~ ~ ~ ~
Institution ~ ↑ ~ ↑ ↑
Age
18–24 (Ref)
25–34 ~ ~ ~ ~ ~
35–44 ~ ↑ ↑ ↑ ↑
Sex Male (Ref)
Female ~ ~ ~ ~ ~
Disabling condition
Cerebral palsy (Ref)
Autism ~ ~ ~ ↑ ~
Intellectual disability ~ ↑ ~ ↑ ↑
Other ~ ~ ~ ~ ~
(Spina bifida, quadriplegia, head injury) Communication
Little/no
effective communication (Ref)
Non-verbally ~ ~ ~ ~ ~
Verbally ~ ~ ~ ~ ~
General health
Very good-Ex (Ref)
Good ~ ~ ~ ~ ~
Poor-Fair ~ ~ ~ ~ ~
Help needed
for self-care
Never/sometimes (Ref)
Always ~ ~ ~ ~ ~
(Ref): reference group ~ no significant difference ↓ significantly lower ↑ significantly higher
77
78 4.4.1.1.2 Stratified analyses of mean DMFT
Among the 18–24 age-group, care recipients in family homes had a significantly higher mean DMFT compared to those in community settings (Figure 4.1). However, that difference was not observed in older age groups. Instead, in the two older age-groups, care recipients in institutions had significantly higher mean DMFT compared to those at community settings. In all age-groups, there was no significant difference in mean DMFT between care recipients at family homes and institutions. This latter finding was in contrast to the result in Table 4.27, where the unadjusted mean DMFT in family settings was significantly lower than the mean DMFT in institutions. The difference in interpretation for Figure 4.1 compared with Table 4.27 comes about because care recipients in the family settings had a much younger age distribution than those in institutions (Table 4.4), and because younger age was strongly associated with a lower mean DMFT (Table 4.27). In other words, the unadjusted findings in Table 4.27 are confounded due to differing age compositions, most notably between family and institutional settings.
Among care recipients with cerebral palsy and intellectual disability, those living in institutions had a significantly higher mean DMFT compared to those in family homes and community settings (Figure 4.2). Similarly, among care recipients with ‘other’ disabling conditions, those living in institutions had a significantly higher mean DMFT compared to those in family homes. However, among those with autism, there was no statistically significant difference in mean DMFT across the residential settings. This latter finding was in contrast to the result in Table 4.27, where the unadjusted mean DMFT in family homes and community housing was significantly lower than the mean DMFT in institutions. The unadjusted findings in Table 4.27 are therefore confounded by differing proportions of disabling conditions in the three residential settings. A high proportion of care recipients with intellectual disability living in institutions (Table 4.4), (associated with a higher mean DMFT compared to other disabling a conditions, Table 4.27) and only four care recipients with cerebral palsy living in institutions (Table 4.4), (associated with a lower mean DMFT compared to other disabling a conditions, Table 4.27), may have resulted in the apparent high unadjusted mean DMFT among care recipients in institutions.
18-24 25-34 35-44 0
5 10
15 Family
Community Institution
Age-group (years)
Mean DMFT (+/-SE)
Residential settings
Figure 4.1 Mean DMFT in the three residential settings, stratified by age-group
Autism
Cerebral palsy
Intellectual disability Other 0
5 10
15 Family
Community Institution
Disabling conditions
Mean DMFT (+/- SE)
Residential settings
Figure 4.2 Mean DMFT in the three residential settings, stratified by disabling condition