Netuveli, Gopalakrishnan S.; (2002) Public health aspects of oral calculus: An analysis of trends and future scenarios. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The public health importance of calculus emanates from its ubiquity as well as the large cost of its removal. The main aim of this thesis was to model future trends in calculus levels based on the epidemiology of calculus, and changes in demography, cigarette smoking, and patterns of using anti-calculus toothpastes. The methods used included epidemiological analysis using regression modelling, meta-analysis and an algorithm-based estimation of scaling time. The results showed that calculus was universally present and was more in the socially disadvantaged, less educated, irregular dental attendee, those brushing the teeth less frequently, and in smokers. The systematic review of clinical trials revealed that anti-calculus toothpastes might reduce calculus by 27% after 3 months, 34% after 6 months and 54% after 12 months use. A per capita scaling time of 15 minutes was found for both British and American populations and the scaling times varied according to the social class, education, dental attendance behaviour, toothbrushing habits and smoking. Different scenarios tested showed that reduction in the scaling time might occur when the proportion of smokers was reduced and number of people brushing their teeth more frequently increased. Under the scenario where the widest range of effect sizes for anti-calculus toothpastes were postulated population scaling time may be reduced by 10% while the scenario on the use of the most effective formulation may reduce the time for scaling by 25%. The anti-calculus dentifrice use may prolong the interval between visit to dentist for scaling and narrow the gap between social groups. Reductions in risk factors were essential to feel the full benefit of the preventive agent. In conclusion, improved dental health behaviour, reduced smoking and increasing use of anticalculus toothpastes can result in significant reduction in population scaling times.

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